Responses of black patients and white patients to antihypertensive drugs are similar, study shows
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《英国医生杂志》
The responses of black patients with high blood pressure to commonly used classes of antihypertensive drugs are more similar than previously thought to the responses of white patients, indicates a meta-analysis published last week.
A Medline search (from 1983 to March 2003) and a manual trawl of references to randomised trials identified 15 studies. These studies, which included information on the effect of antihypertensive drugs on blood pressure in black patients and white patients, involved a total of 9307 white and 2902 black patients whose treatments lasted from four to 18 weeks. The studies?findings were pooled separately for each category of antihypertensive drug.
The change in diastolic blood pressure was similar in 83% to 93% of white and black patients, according to the class of antihypertensive drug (Hypertension 2004;43:566-72).
The results showed that 90% (95% confidence interval 81% to 99%) of white and black patients overall who were treated with diuretics had similar falls in diastolic blood pressure. The percentages of patients who responded similarly were 90% (83% to 97%) for b blockers, 95% (92% to 98%) for calcium channel blockers, and 81% (76% to 86%) for angiotensin converting enzyme inhibitors.
On average, b blockers and ACE inhibitors produced a greater fall in blood pressure in white patients (mean reduction in systolic blood pressure of 6 mm Hg) than in black patients (4.6 mm Hg). In contrast, diuretics and calcium channel blockers achieved greater mean reductions in black patients (3.5 mm Hg) than in white patients (2.4 mm Hg). However, in all the studies analysed the difference between white patients and black patients in the size of the blood pressure reduction was smaller than the standard deviation in each group. For example, the difference in systolic blood pressure between black and white patients after treatment with ACE inhibitors was 4.6 mm Hg, whereas the SD within each group was around 12 to 14 mm Hg.
The lead author of the study, Dr Ashwini Seghal, who is associate professor of medicine at Case Western Reserve University, Cleveland, Ohio, said: "It has traditionally been thought that whites respond better to certain antihypertensives, such as b blockers, while blacks respond better to other classes of drugs, such as diuretics. The results of the study showed a small difference between whites and blacks in response to certain antihypertensives, but this was dwarfed by the variation within each race."
Both genetic and environmental factors influence responses to drugs. Dr Seghal commented: "This investigation shows that race is not a good proxy for these genetic and environmental factors. More broadly, it indicates that we should think twice before basing other types of medical treatment on race."(London Susan Mayor)
A Medline search (from 1983 to March 2003) and a manual trawl of references to randomised trials identified 15 studies. These studies, which included information on the effect of antihypertensive drugs on blood pressure in black patients and white patients, involved a total of 9307 white and 2902 black patients whose treatments lasted from four to 18 weeks. The studies?findings were pooled separately for each category of antihypertensive drug.
The change in diastolic blood pressure was similar in 83% to 93% of white and black patients, according to the class of antihypertensive drug (Hypertension 2004;43:566-72).
The results showed that 90% (95% confidence interval 81% to 99%) of white and black patients overall who were treated with diuretics had similar falls in diastolic blood pressure. The percentages of patients who responded similarly were 90% (83% to 97%) for b blockers, 95% (92% to 98%) for calcium channel blockers, and 81% (76% to 86%) for angiotensin converting enzyme inhibitors.
On average, b blockers and ACE inhibitors produced a greater fall in blood pressure in white patients (mean reduction in systolic blood pressure of 6 mm Hg) than in black patients (4.6 mm Hg). In contrast, diuretics and calcium channel blockers achieved greater mean reductions in black patients (3.5 mm Hg) than in white patients (2.4 mm Hg). However, in all the studies analysed the difference between white patients and black patients in the size of the blood pressure reduction was smaller than the standard deviation in each group. For example, the difference in systolic blood pressure between black and white patients after treatment with ACE inhibitors was 4.6 mm Hg, whereas the SD within each group was around 12 to 14 mm Hg.
The lead author of the study, Dr Ashwini Seghal, who is associate professor of medicine at Case Western Reserve University, Cleveland, Ohio, said: "It has traditionally been thought that whites respond better to certain antihypertensives, such as b blockers, while blacks respond better to other classes of drugs, such as diuretics. The results of the study showed a small difference between whites and blacks in response to certain antihypertensives, but this was dwarfed by the variation within each race."
Both genetic and environmental factors influence responses to drugs. Dr Seghal commented: "This investigation shows that race is not a good proxy for these genetic and environmental factors. More broadly, it indicates that we should think twice before basing other types of medical treatment on race."(London Susan Mayor)