Abstract
BackgroundAmong African-Americans adults, arterial hypertension is both more prevalent and associated with more complications than among white adults. Hypertension is also epidemic among black adults in sub-Saharan Africa. The treatment of hypertension among black adults may be complicated by lesser response to certain classes of anti-hypertensive agents.MethodsWe systematically searched literature for clinical trials of ACE-inhibitors among hypertensive adults comparing blood pressure response between whites and blacks. Meta-analysis was performed to determine the difference in systolic and diastolic blood pressure response. Further analysis including meta-regressions, funnel plots, and one-study-removed analyses were performed to investigate possible sources of heterogeneity or bias.ResultsIn a meta-analysis of 13 trials providing 17 different patient groups for evaluation, black race was associated with a lesser reduction in systolic (mean difference: 4.6 mmHg (95% CI 3.5-5.7)) and diastolic (mean difference: 2.8 mmHg (95% CI 2.2-3.5)) blood pressure response to ACE-inhibitors, with little heterogeneity. Meta-regression revealed only ACE-inhibitor dosage as a significant source of heterogeneity. There was little evidence of publication bias.ConclusionsBlack race is consistently associated with a clinically significant lesser reduction in both systolic and diastolic blood pressure to ACE-inhibitor therapy in clinical trials in the USA and Europe. In black adults requiring monotherapy for uncomplicated hypertension, drugs other than ACE-inhibitors may be preferred, though the proven benefits of ACE-inhibitors in some sub-groups and the large overlap of response between blacks and whites must be remembered. These data are particularly important for interpretation of clinical drug trials for hypertensive black adults in sub-Saharan Africa and for the development of treatment recommendations in this population.
Highlights
Among African-Americans adults, arterial hypertension is both more prevalent and associated with more complications than among white adults
In a recent large community-based study in Tanzania, for example, 21% of black adults between the ages of 35– 44 years had hypertension; of these, only 18% were aware of their diagnosis, only 14% were on treatment, and only 5% were controlled [8]
Several studies among black adults in Nigeria and South Africa have consistently reported that 15-20% of all hospital admissions in Africa are due to hypertension-related diagnoses [9,10,11,12]
Summary
Among African-Americans adults, arterial hypertension is both more prevalent and associated with more complications than among white adults. Among black adults in the USA, for example, 44.4% of men and 43.9% of women have hypertension compared to 33.3%. In sub-Saharan Africa, hypertension is epidemic among black adults. In a recent large community-based study in Tanzania, for example, 21% of black adults between the ages of 35– 44 years had hypertension; of these, only 18% were aware of their diagnosis, only 14% were on treatment, and only 5% were controlled [8]. Several studies among black adults in Nigeria and South Africa have consistently reported that 15-20% of all hospital admissions in Africa are due to hypertension-related diagnoses [9,10,11,12]. Autopsy and death certificate studies show that a large proportion of inhospital deaths are hypertension-related even among younger adults [13,14,15,16]
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