Systematic review: antihypertensive drug therapy in patients of African and South Asian ethnicity.

Lizzy M Brewster,Lizzy M Brewster,Glenn P Oehlers,Gert A Van Montfrans,Gert A Van Montfrans,Yackoob K Seedat

doi:10.1007/s11739-016-1422-x

Abstract

Despite the large differences in the epidemiology of hypertension across Europe, treatment strategies are similar for national populations of white European descent. However, hypertensive patients of African or South Asian ethnicity may require ethnic-specific approaches, as these population subgroups tend to have higher blood pressure at an earlier age that is more difficult to control, a higher occurrence of diabetes, and more target organ damage with earlier cardiovascular mortality. Therefore, we systematically reviewed the evidence on antihypertensive drug treatment in South Asian and African ethnicity patients. We used the Cochrane systematic review methodology to retrieve trials in electronic databases including CENTRAL, PubMed, and Embase from their inception through November 2015; and with handsearch. We retrieved 4596 reports that yielded 35 trials with 7 classes of antihypertensive drugs in 25,540 African ethnicity patients. Aside from the well-known blood pressure efficacy of calcium channel blockers and diuretics, with lesser effect of ACE inhibitors and beta-blockers, nebivolol was not more effective than placebo in reducing systolic blood pressure levels. Trials with morbidity and mortality outcomes indicated that lisinopril and losartan-based therapy were associated with a greater incidence of stroke and sudden death. Furthermore, 1581 reports yielded 16 randomized controlled trials with blood pressure outcomes in 1719 South Asian hypertensive patients. In contrast with the studies in African ethnicity patients, there were no significant differences in blood pressure lowering efficacy between drugs, and no trials available with mortality outcomes. In conclusion, in patients of African ethnicity, treatment initiated with ACE inhibitor or angiotensin II receptor blocker monotherapy was associated with adverse cardiovascular outcomes. We found no evidence of different efficacy of antihypertensive drugs in South Asians, but there is a need for trials with morbidity and mortality outcomes. Screening for cardiovascular risk at a younger age, treating hypertension at lower thresholds, and new delivery models to find, treat and follow hypertensives in the community may help reduce the excess cardiovascular mortality in these high-risk groups.

Highlights

The increasing ethnic diversity of the European population is likely to bring a greater diversity in disease and disease patterns to the doctor’s office
We found no evidence of different efficacy of antihypertensive drugs in South Asians, but there is a need for trials with morbidity and mortality outcomes
Trials were clinically comparable in describing the results of randomized controlled interventions with antihypertensive drugs in African ethnicity patients with hypertension, but the age range, inclusion blood pressure, drugs and drug dose varied (Tables 1, 2)

Summary

Introduction

The increasing ethnic diversity of the European population is likely to bring a greater diversity in disease and disease patterns to the doctor’s office. Despite the large differences in the epidemiology of hypertension across Europe [2], treatment strategies tend to be similar for national populations of white European descent. In particular patients of South Asian and sub-Saharan African descent tend to have more hypertension and diabetes, and more target organ damage and cardiovascular mortality at a younger age than patients of white European descent. Hypertension occurs earlier in life in these patients groups, bringing about a faster progression from normotension to hypertension, with higher mean blood pressures than in white patients [3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]

Methods

Results

Conclusion