title: Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks.
abstract: BACKGROUND
  Angiotensin-converting enzyme inhibitors are used widely in the treatment of patients with hypertension. However, their efficacy in hypertensive blacks when compared with other antihypertensive agents is not well established.
  
  
  METHODS
  We performed a cohort study of patients using data from a clinical data warehouse of 434,646 patients from New York City's Health and Hospitals Corporation from January 2004 to December 2009. Patients were divided into the following comparison groups: angiotensin-converting enzyme inhibitors vs calcium channel blockers, angiotensin-converting enzyme inhibitors vs thiazide diuretics, and angiotensin-converting enzyme inhibitors vs β-blockers. The primary outcome was a composite of death, myocardial infarction, and stroke. Secondary outcomes included the individual components and heart failure.
  
  
  RESULTS
  In the propensity score-matched angiotensin-converting enzyme inhibitors vs calcium channel blocker comparison cohort (4506 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.19-1.77; P = .0003), myocardial infarction (HR, 3.40; 95% CI, 1.25-9.22; P = .02), stroke (HR, 1.82; 95% CI, 1.29-2.57; P = .001), and heart failure (HR, 1.77; 95% CI, 1.30-2.42; P = .0003) when compared with calcium channel blockers. For the angiotensin-converting enzyme inhibitors vs thiazide diuretics comparison (5337 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (HR, 1.65; 95% CI, 1.33-2.05; P < .0001), death (HR, 1.35; 95% CI, 1.03-1.76; P = .03), myocardial infarction (HR, 4.00; 95% CI, 1.34-11.96; P = .01), stroke (HR, 1.97; 95% CI, 1.34-2.92; P = .001), and heart failure (HR, 3.00; 95% CI, 1.99-4.54; P < .0001). For the angiotensin-converting enzyme inhibitors vs β-blocker comparison, the outcomes between the groups were not significantly different.
  
  
  CONCLUSIONS
  In a real-world cohort of hypertensive blacks, angiotensin-converting enzyme inhibitors were associated with a higher risk of cardiovascular events when compared with calcium channel blockers or thiazide diuretics.
authors.affiliation: The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York. Electronic address: sripalbangalore@gmail.com.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.affiliation: Department of Population Health, New York University School of Medicine, New York; New York University Global Institute of Public Health, New York.
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.affiliation: Department of Population Health, New York University School of Medicine, New York.
authors.forename: Joyce
authors.initials: J
authors.lastname: Gyamfi
authors.affiliation: Department of Population Health, New York University School of Medicine, New York.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia.
authors.forename: Jason
authors.initials: J
authors.lastname: Roy
authors.affiliation: Department of Population Health, New York University School of Medicine, New York.
authors.forename: Keith
authors.initials: K
authors.lastname: Goldfeld
authors.affiliation: Department of Population Health, New York University School of Medicine, New York.
authors.forename: Christopher
authors.initials: C
authors.lastname: Torgersen
authors.affiliation: New York City Health and Hospitals Cooperation, New York; Department of Medicine, New York University School of Medicine, New York.
authors.forename: Louis
authors.initials: L
authors.lastname: Capponi
authors.affiliation: Morehouse School of Medicine, Atlanta, Ga.
authors.forename: Christopher
authors.initials: C
authors.lastname: Phillips
authors.affiliation: Kaiser Foundation Hospital & Health Plan, Pasadena, Calif.
authors.forename: Nirav R
authors.initials: NR
authors.lastname: Shah
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D009519:New York City; D020521:Stroke / Q000208:ethnology / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents
keywords: Angiotensin-converting enzyme inhibitors; Blacks; Hypertension