Comparative Antihypertensive Efficacy of Angiotensin Receptor Blocker-Based Treatment in African-American and White Patients

Authors

  • George L. Bakris MD,

    1. From the Department of Preventive Medicine, Rush University Medical Center, Chicago, IL;1Orange Research Center, Tustin, CA;2Division of Cardiology, Louisiana State University Medical Center, New Orleans, LA;3Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT;4Boehringer Ingelheim Pharmaceuticals, Inc.; Ridgefield, CT;5 and State University of New York Downstate College of Medicine, Brooklyn, NY6
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  • 1 David H.G. Smith MD,

    1. From the Department of Preventive Medicine, Rush University Medical Center, Chicago, IL;1Orange Research Center, Tustin, CA;2Division of Cardiology, Louisiana State University Medical Center, New Orleans, LA;3Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT;4Boehringer Ingelheim Pharmaceuticals, Inc.; Ridgefield, CT;5 and State University of New York Downstate College of Medicine, Brooklyn, NY6
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  • 2 Thomas D. Giles MD,

    1. From the Department of Preventive Medicine, Rush University Medical Center, Chicago, IL;1Orange Research Center, Tustin, CA;2Division of Cardiology, Louisiana State University Medical Center, New Orleans, LA;3Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT;4Boehringer Ingelheim Pharmaceuticals, Inc.; Ridgefield, CT;5 and State University of New York Downstate College of Medicine, Brooklyn, NY6
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  • 3 William B. White MD,

    1. From the Department of Preventive Medicine, Rush University Medical Center, Chicago, IL;1Orange Research Center, Tustin, CA;2Division of Cardiology, Louisiana State University Medical Center, New Orleans, LA;3Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT;4Boehringer Ingelheim Pharmaceuticals, Inc.; Ridgefield, CT;5 and State University of New York Downstate College of Medicine, Brooklyn, NY6
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  • 4 Giora Davidai MD,

    1. From the Department of Preventive Medicine, Rush University Medical Center, Chicago, IL;1Orange Research Center, Tustin, CA;2Division of Cardiology, Louisiana State University Medical Center, New Orleans, LA;3Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT;4Boehringer Ingelheim Pharmaceuticals, Inc.; Ridgefield, CT;5 and State University of New York Downstate College of Medicine, Brooklyn, NY6
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  • and 5 Michael A. Weber MD 6

    1. From the Department of Preventive Medicine, Rush University Medical Center, Chicago, IL;1Orange Research Center, Tustin, CA;2Division of Cardiology, Louisiana State University Medical Center, New Orleans, LA;3Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT;4Boehringer Ingelheim Pharmaceuticals, Inc.; Ridgefield, CT;5 and State University of New York Downstate College of Medicine, Brooklyn, NY6
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George L. Bakris, MD, Vice Chairman, Department of Preventive Medicine, Rush University Medical Center, 1700 West Van Buren, Suite 470, Chicago, IL 60612
E-mail: gbakris@earthlink.net

Abstract

Blood pressure (BP) reuctions with agents that block the renin-angiotensin system are regarded as less effective as monotherapy in African Americans than other ethnic groups. This practice-based study compares the efficacy of an angiotensin receptor blocker-based regimen in African-American and Caucasian patients. Included in the 10-week study were 173 African-American and 1296 Caucasian patients. Efficacy was based on differences in 24-hour ambulatory BP. After baseline ambulatory BP monitoring and office BPs were obtained, all patients were started or switched to the angiotensin receptor blocker telmisartan, 40–80 mg daily, plus hydro-chlorothiazide 12.5 mg daily (if needed for office BP control: <140/90 mm Hg). More African Americans required the addition of a low-dose thiazide diuretic than Caucasians (47.3% vs. 34.9%; p=0.021). Once patients with white coat hypertension were excluded (i.e., those with baseline ambulatory BP monitoring <130/80 mm Hg), ambulatory BP monitoring changes were similar between groups. A greater proportion of African Americans than Caucasians without white coat hypertension also needed combination therapy (52.1% vs. 39.5%; p=0.04). While achievement of BP goal was similar between groups by office criterion (<140/90 mm Hg), differences were noted by ambulatory BP monitoring (<130/80 mm Hg) (48.0% in African American vs. 63.2% in Caucasians; p=0.01) despite the same BP reductions, reflecting higher baseline values in African Americans. We conclude that an angiotensin receptor blocker as part of a BP-lower-ing strategy is effective in previously untreated African-American patients, although a higher proportion will require the use of a diuretic compared with Caucasians.

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