20 Mar Study Emphasizes Need to Establish Optimal Pressure Combination Therapies by Ethnicity
MedicalResearch.com Interview with:
Dike B. Ojji, M.D., Ph.D, FWACP, FACP
Department of Medicine
Faculty of Clinical Sciences
University of Abuja
MedicalResearch.com: What is the background for this study?
Response: We decided to do this research because there were no large RCTs before now that have compared the efficacy of contemporary combination therapies among any black populations in spite of the high burden of hypertension and its complications (such as heart failure, cerebrovascular accident and chronic kidney) in this population, and also the fact that majority require 2 or more medications to control their blood pressure.
MedicalResearch.com: What are the main findings?
Response: Combinations containing the long acting calcium channel blockers (Amlodipine plus Hydrochlorothiazide and Amlodipine plus Perindopril) were more efficacious compared to the combination without long acting calcium channel blocker (Perindopril plus Hydrochlorothiazide).
MedicalResearch.com: What should readers take away from your report?
Response: Anti-hypertensive combination therapy in Black Africans should centre around long-acting calcium channel blockers like Amlodipine.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our results emphasise the need to establish optimal 2 or 3 drug anti- hypertensive combination therapies by ethnicity for example in S. Asians.
It will also be nice to carry the same project in African Americans and compare with our results as it is difficult to completely extrapolate our work completely to African Americans because of gene environment interaction and genetic admixture.
MedicalResearch.com: Is there anything else you would like to add?
Response: For Black patients especially of in sub Saharan Africa, combinations of calcium channel blockers plus RAAS blockers, and calcium channel blockers and thiazide or thiazide like diuretics are preferred to combinations of RAAS blockers and thiazide or thiazide diuretics in controlling blood pressure. However, final choice should depend on accessibility, availability, cost and side effect profile, thereby emphasizing the need for individualising treatment.
Comparison of Dual Therapies for Lowering Blood Pressure in Black Africans D.B. Ojji, B. Mayosi,* V. Francis, M. Badri, V. Cornelius, W. Smythe, N. Kramer, F. Barasa, A. Damasceno, A. Dzudie, E. Jones, C. Mondo, O. Ogah, E. Ogola, M.U. Sani, G.L. Shedul, G. Shedul, B. Rayner, I.G. Okpechi, K. Sliwa, and N. Poulter, for the CREOLE Study Investigators†
This article was published on March 18, 2019, at NEJM.org. DOI: 10.1056/NEJMoa1901113 Copyright © 2019 Massachusetts Medic
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