Hypertensive Black Patients Have Worse Outcomes From ACE Inhibitor Therapy

Gbenga Ogedegbe, MD, MS, MPH FACP Professor of Population Health and Medicine Director, Division of Health and Behavior Director, Center for Healthful Behavior Change Vice Dean, NYU College of Global Public Health NYU Langone School of Medicine Department of Population Health New York, NY 10016MedicalResearch.com Interview with:
Gbenga Ogedegbe, MD, MS, MPH FACP
Professor of Population Health and Medicine
Director, Division of Health and Behavior
Director, Center for Healthful Behavior Change
Vice Dean,  NYU College of Global Public Health
NYU Langone School of Medicine
Department of Population Health
New York, NY 10016

Medical Research: What is the background for this study?

Dr. Ogedebge: Evidence from clinical trials have previously indicated that a common blood pressure medication, angiotensin-converting-enzyme (ACE) inhibitors, (when prescribed as first line treatment) may not provide the same benefits in blacks compared to whites. However blacks are grossly underrepresented in these studies, despite the fact they have disproportionately higher rates of hypertension-related morbidity and mortality than whites. Thus, we chose to study this particular question because it allows us to evaluate this evidence in a large population of hypertensive black patients who receive care in a real-world practice setting. This study evaluates racial differences in cardiovascular outcomes and mortality between hypertensive black and white patients whose treatment was initiated with angiotensin-converting-enzyme (ACE) inhibitors, outside of a clinical trial.  ACE inhibitors are one of several classes of drugs commonly prescribed to individuals with hypertension to prevent deaths, heart attack, kidney failure, heart failure and stroke.

Medical Research: What are the main findings?

Dr. Ogedebge:  This is the largest practice-based study of comparative effectiveness of initiation of treatment with ACE Inhibitors compared to other antihypertensive medications in blacks and whites with hypertension.

The main findings from this study are that hypertensive black patients have poorer cardiovascular outcomes when treatment is initiated with ACE-Inhibitors compared to initiation of treatment with other blood pressure medications. Specifically, hypertensive blacks whose treatment was initiated with ACE inhibitors had higher rates of cardiovascular events, and were at higher risk of the composite outcome of all-cause mortality, nonfatal heart attack, or nonfatal stroke than whites.

Medical Research: What should clinicians and patients take away from your report?

Dr. Ogedebge: The main take away message is that ACE inhibitors should not be prescribed as first-line treatment  in black patients with uncontrolled high blood pressure.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Ogedebge: Additional research is needed to elucidate the mechanisms for the racial disparaties in outcomes between blacks and whites.

Citation:

Ogedegbe G, Shah NR, Phillips C, et al. Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitor-Based Treatment on Cardiovascular Outcomes in Hypertensive Blacks Versus Whites. J Am Coll Cardiol. 2015;66(11):1224-1233. doi:10.1016/j.jacc.2015.07.021.

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Gbenga Ogedegbe, MD, MS (2015). Hypertensive Black Patients Have Worse Outcomes From ACE Inhibitor Treatment 

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