Dual therapies combining a calcium-channel blocker with an angiotensin-converting enzyme (ACE) inhibitor or thiazide diuretic are more effective at lowering blood pressure in black African patients than the combination of an ACE inhibitor and a thiazide diuretic, according to results presented at ACC.19.
Dual therapies are needed in many patients to control blood pressure effectively; however, recommendations for combination therapies in black patients differ across three guidelines in the USA and the latest European guidelines. “We decided to do this research because before now no large randomized controlled trials have compared the efficacy of contemporary combination therapies among any black populations, in spite of the high burden of hypertension and its complications in this population,” explains Dike Ojji, corresponding author.
In this trial, 728 black patients with uncontrolled hypertension from six countries in sub-Saharan Africa were randomly assigned to receive amlodipine (a calcium-channel blocker) and hydrochlorothiazide (a thiazide diuretic), amlodipine and perindopril (an ACE inhibitor) or perindopril and hydrochlorothiazide. The primary end point was change in 24-h ambulatory systolic blood pressure between baseline and 6 months.
Patients who received either of the combinations containing amlodipine had a larger reduction in blood pressure than those patients who received perindopril and hydrochlorothiazide. The efficacy of calcium-channel blockers as monotherapy in black patients is well established, and the results from this study suggest that a calcium-channel blocker might also be the vital component in dual therapies.
“A calcium-channel blocker might also be the vital component in dual therapies”
“This study emphasizes the need to establish optimal antihypertensive combination therapies by ethnicity,” says Ojji. “It would also be interesting to carry out the same project in African Americans and compare results as it is difficult to extrapolate our work to this population because of gene–environment interaction and genetic admixture.”
Ojji, D. B. et al. Comparison of dual therapies for lowering blood pressure in Black Africans. N. Engl. J. Med. https://doi.org/10.1056/NEJMoa1901113 (2019)
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Leake, I. Lowering blood pressure in black African patients. Nat Rev Cardiol 16, 323 (2019). https://doi.org/10.1038/s41569-019-0193-2