Ethnic differences in responses to cardiovascular drugs

Abstract

Ethnic differences in therapeutic response or adverse reactions may be due to genetic factors, differences in body composition, and diet. Black individuals tend to be more responsive to thiazides and less so to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers. The risk of angio-oedema with ACEIs is increased. In contrast, the isosorbide–hydralazine combination is approved for treating heart failure only in black patients. Chinese patients have a higher incidence of ACEI-induced cough. They are more susceptible to myositis with high-dose statins. A proportion of Asian patients have poor cytochrome P450 2C19 activity and are less capable of metabolizing clopidogrel to its active form. The target international normalized ratio for Chinese patients is also 2–3, but the maintenance dose of warfarin is usually lower than in Caucasians. Regardless of ethnicity, control of hypertension and dyslipidaemia, and antiplatelet therapy all help to reduce cardiovascular complications. Attention to dose, interacting drugs, and pharmacogenetics should help to make drugs safer in every ethnic group.