The purpose of this study was to assess the effects of reninangiotensin system (RAS) inhibitors vs other antihypertensive agents on cardiovascular outcomes in hypertensive black patients. The authors performed a systematic review and meta-analysis of studies that compared the effects of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) with calcium channel blockers (CCBs), diuretics, and b-blockers in hypertensive black patients on cardiovascular outcomes. A total of 38,983 patients with a mean age of 60 years and mean follow-up of 4 years were included in our meta-analysis. No significant differences were found in all-cause mortality, myocardial infarction, heart failure, and cardiovascular mortality rates among patients treated with RAS inhibitors compared with CCBs, diuretics, and b-blockers. The incidence of stroke was significantly increased in patients treated with RAS inhibitors compared with CCBs (odds ratio, 1.56; 95% confidence interval, 1. Hypertension (HTN) in African Americans is often more severe and resistant to antihypertensive therapy and leads to earlier target organ damage and higher cardiovascular (CV) events compared with whites. [1][2][3] Response to antihypertensive drug classes may be different among different age and race subgroups. Black and elderly patients exhibit better blood pressure (BP) response to thiazide diuretics or long-acting calcium channel blockers (CCBs), provided they don't have a specific indication for angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) such as heart failure (HF) or proteinuric chronic kidney disease. 4 In contrast, younger white patients respond better to ACE inhibitors or ARBs.4-6 The observed differences may be the result of lower plasma renin activity in hypertensive blacks.7 A recent analysis of New York City Health and Hospital Corporation's clinical data showed significantly higher all-cause mortality and myocardial infarction (MI) rates in hypertensive blacks treated with ACE inhibitors. 8 We sought to review and analyze CV outcomes in hypertensive blacks treated with different antihypertensive classes.
METHODS
Search StrategySystematic electronic search was performed on MED-LINE (PubMed interface), Embase, and Cochrane Central Registry of Controlled Trials (CENTRAL) with no language limitations. Using the MESH terms, we searched the following key terms: hypertension, blacks, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, and b-blockers. Two reviewers (M.P. and A.B.) independently screened titles and abstracts based on inclusion and exclusion criteria. After eliminating irrelevant studies, full-text reports were reviewed. Review articles were excluded. Subsequently, we performed a hand search of all included randomized clinical trials and observational studies until no further relevant studies were identified. Finally, a total of four studies were identified.
Study SelectionWe included randomized clinical trials...