Management of High Blood Pressure in Blacks

Flack, John M.; Sica, Domenic A.; Bakris, George L.; Brown, Angela L.; Ferdinand, Keith C.; Grimm, Richard H.; Hall, W. Dallas; Jones, Wendell E.; Kountz, David S.; Lea, Janice P.; Nasser, Samar A.; Nesbitt, Shawna D.; Saunders, Elijah; Scisney-Matlock, Margaret; Jamerson, Kenneth

doi:10.1161/hypertensionaha.110.152892

Cited by 388 publications

(250 citation statements)

References 169 publications

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“…Also, these patients were followed for only 2 years and the main treatment drug was a long‐acting calcium channel blocker (CCB). Diuretics, widely considered first line along with CCBs in most professional society guidelines, were used in only 12% of the patients 7, 11, 12, 13. While not reaching statistical significance, subgroup analysis suggested that intensive treatment goals may be beneficial in patients <75 years old while adopting a more liberal strategy may be safer in those ≥75 years old 10…”

Section: Jnc 8 Recommendationmentioning

confidence: 99%

“…In the black population with hypertension, CCBs and thiazide diuretics generally tend to be favored as initial therapy over renin‐angiotensin system blockers 13, 14, 45. The evidence for this recommendation comes from ALLHAT, which showed in prespecified subgroup analysis that black patients treated with lisinopril had higher rates of stroke, CVD, and HF plus 4 mm Hg higher SBP compared with those treated with chlorthalidone 49…”

Section: Jnc 8 Recommendations 6 Tomentioning

confidence: 99%

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US Hypertension Management Guidelines: A Review of the Recent Past and Recommendations for the Future

Kovell

Ahmed

Misra

et al. 2015

JAHA

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Section: Jnc 8 Recommendationmentioning

confidence: 99%

Section: Jnc 8 Recommendations 6 Tomentioning

confidence: 99%

US Hypertension Management Guidelines: A Review of the Recent Past and Recommendations for the Future

Kovell

Ahmed

Misra

et al. 2015

JAHA

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“…On clinical grounds, as doxazosin is an ␣-blocker, dropping the CTDN-doxazosin trial is justified by the little or no support for ␣-blockers in recent hypertension guidelines. 11,36 For consistency, we choose to report results from the z statistic, which has the advantage of a more conservative P value.…”

Section: Osbp-adjusted Network Meta-analysismentioning

confidence: 99%

“…5,6 In the last several years, some have compared the drugs pharmacologically and have recommended CTDN rather than HCTZ. 3,[7][8][9][10][11][12] Two recent reanalyses of Multiple Risk Factor Intervention Trial (MRFIT) data have found CTDN to be superior to HCTZ in reducing cardiovascular events (CVEs) 13 and left ventricular hypertrophy. 14 However, no randomized, controlled trials have compared the 2 medications head to head with respect to CVEs.…”

mentioning

confidence: 99%

Chlorthalidone Compared With Hydrochlorothiazide in Reducing Cardiovascular Events

2012

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Abstract-Hydrochlorothiazide (HCTZ) is widely used for hypertension, and prescriptions for HCTZ outnumber those for chlorthalidone (CTDN) by Ͼ20-fold in 2 recent surveys. Some have recently expressed a preference for CTDN. However, head-to-head trials testing the effect of the 2 drugs on cardiovascular events (CVEs) are lacking. We conducted a systematic review of randomized trials in which 1 arm was based on either HCTZ or CTDN followed by 2 types of network meta-analyses, a drug-adjusted analysis and an office systolic blood pressure-adjusted analysis. Nine trials were identified: 3 based on HCTZ and 6 based on CTDN. In the drug-adjusted analysis (nϭ50 946), the percentage of risk reduction in congestive heart failure for CTDN versus HCTZ was 23 (95% CI, 2-39; Pϭ0.032); and in all CVEs was 21 (95% CI, 12-28; PϽ0.0001). In the office systolic blood pressure-adjusted analysis (nϭ78 350), the percentage of risk reduction in CVEs for CTDN versus HCTZ was 18 (95% CI, Pϭ0.024). When the reduction in office systolic blood pressure was identical in the 2 arms, the risk for CVEs in HCTZ arms was 19% higher than in its nondiuretic comparator arms (Pϭ0.021). Relative to HCTZ, the number needed to treat with CTDN to prevent 1 CVE over 5 years was 27. In conclusion, CTDN is superior to HCTZ in preventing cardiovascular events. This cannot be attributed entirely to the lesser effect of HCTZ on office systolic blood pressure but may be attributed to the pleomorphic effects of alternative medications or to the short duration of action of HCTZ. Pharmaceutical preparations of the 2 drugs differ. HCTZ is available in 12.5-mg and 25.0-mg tablets and in 19 combination tablets, whereas CTDN is commonly available only in an unscored 25-mg tablet, an excessive dose in many patients, and in only 3 combination tablets, including atenolol, clonidine, and azilsartan. In light of the practical features of HCTZ, 2 there were 134 million prescriptions (solo or as a combination tablet) in 2007. 3 HCTZ is the 10th most commonly prescribed drug in the United States, with 48 million solo prescriptions annually from 2006 through 2010. 4 In 2 recent surveys, one in the United States and the other in Germany, HCTZ prescriptions outnumbered those for CTDN by Ͼ20-fold. 5,6 In the last several years, some have compared the drugs pharmacologically and have recommended CTDN rather than HCTZ. 3,[7][8][9][10][11][12] Two recent reanalyses of Multiple Risk Factor Intervention Trial (MRFIT) data have found CTDN to be superior to HCTZ in reducing cardiovascular events (CVEs) 13 and left ventricular hypertrophy. 14 However, no randomized, controlled trials have compared the 2 medications head to head with respect to CVEs. To examine whether 1 drug was superior over the other in reducing CVEs, we undertook a systematic review of randomized, controlled trials with either HCTZ or CTDN as the step 1 agent and then conducted 2 different types of network analyses. MethodsPreferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines were followed th...

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“…Although there are indications for specific classes of antihypertensive drugs for particular patients, such as diuretics for hypertensive African Americans, 1 there is no uniform agreement on the type of drug(s) that should be used when physicians choose an antihypertensive drug for newly diagnosed patients without specific indications for those drugs.…”

Section: Introductionmentioning

confidence: 99%

Sex differences in response to angiotensin II receptor blocker-based therapy in elderly, high-risk, hypertensive Japanese patients: a subanalysis of the OSCAR study

et al. 2014

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for the OlmeSartan Calcium Antagonists Randomized (OSCAR) Study GroupThe OlmeSartan Calcium Antagonists Randomized (OSCAR) study is a multicenter, prospective, randomized, open-label, blinded, end point study of elderly hypertensive Japanese patients that compared the efficacy of a high-dose angiotensin II receptor blocker (ARB) treatment to an ARB plus calcium channel blocker (CCB) combination. In this pre-specified subgroup analysis, we compared the response to such therapy according to sex. A total of 1164 patients (515 (44%) men and 649 (56%) women) were included, and each gender was split into two nearly equal treatment groups. The primary end point was a composite of cardiovascular events and non-cardiovascular death. The baseline characteristics between the two treatment groups in each sex were similar, except for some variables. Male patients had lower systolic and higher diastolic blood pressure than female patients (156.8/85.7 vs. 158.5/84.2 mm Hg). At the end of the study, the mean systolic pressure was higher in the ARB group (134.4 mm Hg) than in the ARB plus CCB group (131.5 mm Hg; P ¼ 0.03) for men but not for women (135.4 vs. 133.4 mm Hg; P ¼ 0.12). For men, the primary outcome events tended to be higher in the ARB group than in the ARB plus CCB group (hazard ratio (HR) ¼ 1.66; P ¼ 0.055) but not for women (HR ¼ 0.97; P ¼ 0.92). This difference in men was due to cardiovascular events (HR ¼ 1.86; P ¼ 0.03). The interaction between sex and treatment group was not significant (P ¼ 0.17). These findings suggest that, in addition to blood pressure control, appropriate patient risk assessment is important for the treatment of hypertension, especially in male patients, as opposed to possible sex differences in treatment effects.

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Management of High Blood Pressure in Blacks

Cited by 388 publications

References 169 publications

US Hypertension Management Guidelines: A Review of the Recent Past and Recommendations for the Future

US Hypertension Management Guidelines: A Review of the Recent Past and Recommendations for the Future

Chlorthalidone Compared With Hydrochlorothiazide in Reducing Cardiovascular Events

Sex differences in response to angiotensin II receptor blocker-based therapy in elderly, high-risk, hypertensive Japanese patients: a subanalysis of the OSCAR study

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