Antihypertensive Medication Use and Its Effects on Blood Pressure and Haemodynamics in a Tri-ethnic Population Cohort: Southall and Brent Revisited (SABRE).

Alun D Hughes,Therese Tillin,Sophie V Eastwood,Nish Chaturvedi

doi:10.3389/fcvm.2021.795267

Abstract

Objectives:We characterised differences in BP control and use of antihypertensive medications in European (EA), South Asian (SA) and African-Caribbean (AC) people with hypertension and investigated the potential role of type 2 diabetes (T2DM), reduced arterial compliance (Ca), and antihypertensive medication use in any differences.Methods:Analysis was restricted to individuals with hypertension [age range 59–85 years; N = 852 (EA = 328, SA = 356, and AC =168)]. Questionnaires, anthropometry, BP measurements, echocardiography, and fasting blood assays were performed. BP control was classified according to UK guidelines operating at the time of the study. Data were analysed using generalised structural equation models, multivariable regression and treatment effect models.Results:SA and AC people were more likely to receive treatment for high BP and received a greater average number of antihypertensive agents, but despite this a smaller proportion of SA and AC achieved control of BP to target [age and sex adjusted odds ratio (95% confidence interval) = 0.52 (0.38, 0.72) and 0.64 (0.43, 0.96), respectively]. Differences in BP control were partially attenuated by controlling for the higher prevalence of T2DM and reduced Ca in SA and AC. There was little difference in choice of antihypertensive agent by ethnicity and no evidence that differences in efficacy of antihypertensive regimens contributed to ethnic differences in BP control.Conclusions:T2DM and more adverse arterial stiffness are important factors in the poorer BP control in SA and AC people. More effort is required to achieve better control of BP, particularly in UK ethnic minorities.

Highlights

Elevated blood pressure (BP) is a major global public health problem and a leading preventable cause of cardiovascular morbidity and mortality
In the UK and Europe, BP and prevalence of hypertension has generally been found to be higher in people of African/AfricanCaribbean (AC) ethnicity compared with people of European ancestry (EA) [2], findings in South Asian (SA) people are less consistent [3, 4]
We investigated whether responses to major classes of antihypertensive agents differed by ethnicity

Summary

Introduction

Elevated blood pressure (BP) is a major global public health problem and a leading preventable cause of cardiovascular morbidity and mortality. There is evidence that some BP-lowering agents, notably betablockers and inhibitors of the renin-angiotensin system (RAS) are comparatively less effective in people of African ancestry [7, 8], while calcium channel blockers (CCB) and diuretics may be more effective [7,8,9]. There is limited comparable data in SA, but what exists suggests little or no difference in efficacy of antihypertensive agents [11, 12]. On the basis of evidence from trials and mechanistic considerations, the UK National Institute for Health and Care Excellence (NICE) in 2006 recommended that patients of Black African or Black Caribbean ethnicity, should receive either a calcium-channel blocker or a thiazide-type diuretic as first-line therapy [13]

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