Hypertension in black people: pathophysiology and therapeutic aspects

Lopes, Antônio Alberto

doi:10.1038/sj.jhh.1001333

Cited by 18 publications

(12 citation statements)

References 18 publications

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“…Our previous study of anti-hypertensive medicines utilization pattern about 10 years ago showed that ACEIs and beta blockers were the least frequently prescribed 9. The sparse prescribing of ACEIs was associated with the reported relatively lower reduction of blood pressure by ACEIs in the black population especially as monotherapy 15,16. However, this view was challenged by a number of studies which showed that blood pressure response to ACEIs is probably blind to race but sensitive to patients’ factors such as age, body mass index, high entry/baseline blood pressure levels and severe hypertension due to delay in seeking treatment, presence of co-morbidity such as diabetes mellitus and inequity in the access to functional health care 17,18.…”

Section: Introductionmentioning

confidence: 99%

Anti-hypertensive medicines prescribing for medical outpatients in a premier teaching hospital in Nigeria: a probable shift of paradigm

Eshiet

Yusuff

2014

Pharmacy Practice (Internet)

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BackgroundPrevious studies of anti-hypertensive medicines utilization pattern in Nigeria showed that Angiotensin converting enzyme inhibitors (ACEIs) were often the least prescribed. However, the appropriate use of ACEIs in the black population achieves good blood pressure control and provides additional long term cardio- and renovascular protection benefits.ObjectiveTo assess the current utilization pattern of antihypertensive medicines with specific emphasis on identifying possible shift in the frequency of use of ACEIs.MethodsA prospective cross-sectional assessment of the current utilization pattern of anti-hypertensive medicines was conducted among 300 randomly selected cohort at a 900-bed premier Teaching Hospital located in Ibadan, Southwestern Nigeria. The current utilization pattern was compared with the results of a study conducted at the same site and published 10 years ago.ResultsOf the 300 random cohorts, a majority (79%) were females (237) with mean age 58.7 years (SD=2.81 years. Stage 2 hypertension was the most frequent diagnosis (54.3%). The utilization of ACEIs and long acting CCB (amlodipine) significantly increased from 8.6% and 21% (Ten years ago) to 29.93% and 36.68% respectively (p < 0.0001). The use of thiazide diuretic and methyldopa declined significantly from 39.4% and 23.3% (Ten years ago) to 16.12% and 9.7% respectively (p < 0.0001). Adverse drug reactions due to ACEIs were documented in 1.5% (3), while laboratory monitoring of serum potassium, urea and creatinine was conducted in only 37% (111) of cohort. Potentially harmful drug-drug interactions were identified in 25% (75) of cohorts, and the most frequent were ACEIs + NSAIDs (53.3%), ACEIs + amiloride / hydrochlorothiazide (22.6%).ConclusionsAnti-hypertensive medicines utilization has significantly shifted towards the increased use of ACEIs and long acting dihydropyridine CCBs. The use of thiazides and methyldopa has declined significantly. Physicians appeared more cognizant of the long term cardio- and renovascular benefits inherent in using ACEIs in a high cardiovascular risk group such as black hypertensive.

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Section: Introductionmentioning

confidence: 99%

Anti-hypertensive medicines prescribing for medical outpatients in a premier teaching hospital in Nigeria: a probable shift of paradigm

Eshiet

Yusuff

2014

Pharmacy Practice (Internet)

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“…Racial differences may also affect response to hypertensive treatment. In general, hypertension in black patients appears more difficult to control, and blacks have an increased CV risk associated with hypertension; [25][26][27][28][29][30][31] there was a significantly higher proportion of blacks in NA than in CA and especially EA. Specifically, black patients are more likely to have lowrenin hypertension and more frequently carry variant genotypes and haplotypes of the beta-1 adrenergic receptor, making them generally less likely to respond to ACE inhibitors and beta blockers, respectively.…”

Section: Discussionmentioning

confidence: 96%

Global differences in blood pressure control and clinical outcomes in the INternational VErapamil SR‐Trandolapril Study (INVEST)

Zineh

Cooper‐DeHoff

Wessel

et al. 2005

Clinical Cardiology

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Background: The INternational VErapamil SR‐Trandolapril Study (INVEST), a prospective, randomized, antihypertensive trial, found that two different medication regimens produced similar blood pressure (BP) control with equivalent cardiovascular (CV) outcomes (death from any cause, nonfatal myocardial infarction [MI], or nonfatal stroke). Hypothesis: The study was undertaken to investigate whether differences exist by global regions in demographics, treatment, and outcomes in the INVEST trial. Methods: Data were analyzed for 22,576 patients with stable coronary artery disease (CAD) enrolled in INVEST. We investigated differences in patient characteristics, treatment approaches, BP control, and clinical outcomes by creating three global regions based on geographical location: Northern Americas (NA), Caribbean (CA), and Eurasia (EA). Results: We observed significant regional differences in patient characteristics, treatment patterns, BP control, and CV outcomes. At baseline, patients from NA were older and had greater body mass index, higher rates of diabetes, peripheral vascular disease, and coronary revascularization, but lower rates of MI or left ventricular hypertrophy than patients in CA and EA. At 24 months, there were regional differences in both study and nonstudy antihypertensive drug use. Despite having higher mean baseline BP, patients from CA and EA achieved lower mean systolic BP throughout study follow‐up. Furthermore, patients from both CA and EA had lower rates of all‐cause mortality, fatal or nonfatal MI, fatal or nonfatal stroke, and newly diagnosed diabetes than patients from NA. Conclusions: In INVEST, regional differences in medication utilization, BP control, and CV outcomes were identified. These disparities warrant further investigation to define appropriate care for patients with hypertension and stable CAD from an international public health perspective.

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“…17 Another example is the poor immunologic response to vaccination seen in malnourished children. 18,19 Secondly, differences in patient adherence may impact on the effectiveness of an intervention.…”

Section: Do Public Health Interventions In the Guidelines Address A Pmentioning

confidence: 99%

Assessing equity in clinical practice guidelines

Dans

Oxman³

et al. 2007

Journal of Clinical Epidemiology

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Hypertension in black people: pathophysiology and therapeutic aspects

Cited by 18 publications

References 18 publications

Anti-hypertensive medicines prescribing for medical outpatients in a premier teaching hospital in Nigeria: a probable shift of paradigm

Anti-hypertensive medicines prescribing for medical outpatients in a premier teaching hospital in Nigeria: a probable shift of paradigm

Global differences in blood pressure control and clinical outcomes in the INternational VErapamil SR‐Trandolapril Study (INVEST)

Assessing equity in clinical practice guidelines

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