Systematic review: antihypertensive drug therapy in black patients.
BACKGROUND
Hypertension occurs more frequently and is generally more severe in black persons than in white persons, leading to excess morbidity and mortality.


OBJECTIVE
To systematically review the efficacy of different antihypertensive drugs in reducing blood pressure, morbidity, and mortality in hypertensive black adults.


METHODS
The following databases were searched from their inception through November 2003: MEDLINE, EMBASE, LILACS (Literatura Latino-Americana y del Caribe en Ciencias de la Salud), African Index Medicus, and the Cochrane Library. PubMed was also searched from September 2003 through March 2004. Searches were conducted without language restriction.


METHODS
Randomized, controlled trials of drugs versus placebo (blood pressure outcomes) or drugs versus placebo or other drugs (morbidity and mortality outcomes).


METHODS
2 reviewers independently extracted data.


RESULTS
The efficacy of beta-blockers in reducing systolic blood pressure and the efficacy of angiotensin-converting enzyme inhibitors in achieving diastolic blood pressure goals did not significantly differ from that of placebo (weighted mean difference for beta-blockers, -3.53 mm Hg [95% CI, -7.51 to 0.45 mm Hg]; relative risk for angiotensin-converting enzyme inhibitors, 1.35 [CI, 0.81 to 2.26]). In the pooled analyses, other reviewed drugs (calcium-channel blockers, diuretics, central sympatholytics, alpha-blockers, and angiotensin II receptor blockers) were more effective than placebo in reducing blood pressure, but only calcium-channel blockers remained effective in all prespecified subgroups, including patients with a baseline diastolic blood pressure of 110 mm Hg or greater. Main morbidity and mortality outcomes did not differ significantly between treatment groups when drugs were combined to reach blood pressure goals. However, trial results indicated a greater occurrence of diabetes with diuretics and a higher risk for cardiovascular events with drug regimens that included angiotensin-converting enzyme inhibitors.


CONCLUSIONS
This meta-analysis evaluated the blood pressure lowering-efficacy of monotherapy only.


CONCLUSIONS
Drugs differ in their efficacy for reducing blood pressure in black patients, but there is no solid evidence that efficacy for reducing morbidity and mortality outcomes differs once patients achieve the blood pressure goal.
Brewster
Lizzy M
LM
Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
van Montfrans
Gert A
GA
Kleijnen
Jos
J
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D057912:Angiotensin II Type 2 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D044383:Black People; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D013565:Sympatholytics / Q000627:therapeutic use
D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D057912:Angiotensin II Type 2 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D004232:Diuretics; D013565:Sympatholytics