ASCOT Investigators (Including: Gupta, Ajay K., Poulter, Neil R., Dobson, Joanna, Eldridge, Sandra, Cappuccio, Francesco P., Caulfield, Mark, Collier, David, Cruickshank, J. Kennedy, Sever, Peter S. and Feder, Gene). (2010) Ethnic differences in blood pressure response to first and second-line antihypertensive therapies in patients randomized in the ASCOT trial. American Journal of Hypertension, Vol.23 (No.9). pp. 1023-1030. ISSN 0895-7061

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Abstract

BACKGROUND Some studies suggest that blood pressure (BP)-lowering effects of commonly used antihypertensive drugs differ among ethnic groups. However, differences in the response to second-line therapy have not been studied extensively. METHODS In the BP-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-BPLA), BP levels of European (n = 4,368), African (203), and South-Asian-(132) origin patients on unchanged monotherapy (atenolol or amlodipine) and/or on second-line therapy (added thiazide or perindopril) were compared. Interaction between ethnicity and BP responses (defined as end BP minus start of therapy BP) to both first-and second-line therapies were assessed in regression models after accounting for age, sex, and several other potential confounders. RESULTS BP response to atenolol and amlodipine monotherapy differed among the three ethnic groups (interaction test P = 0.05). Among those allocated atenolol monotherapy, black patients were significantly less responsive (mean systolic BP (SBP) difference +1.7 (95% confidence interval: -1.1 to 4.6) mm Hg) compared to white patients (referent). In contrast, BP response to amlodipine monotherapy did not differ significantly by ethnic group. BP responses to the addition of second-line therapy also differed significantly by ethnic group (interaction test P = 0.004). On adding a diuretic to atenolol, BP lowering was similar among blacks and South-Asians as compared to whites (referent). However, on addition of perindopril to amlodipine, BP responses differed significantly: compared to whites (SBP difference -1.7 (-2.8 to -0.7) mm Hg), black patients had a lesser response (SBP difference 0.8 (-2.5 to 4.2) mm Hg) and South-Asians had a greater response (SBP difference -6.2 (-10.2 to -2.2) mm Hg). CONCLUSIONS We found important differences in BP responses among ethnic groups to both first-and second-line antihypertensive therapies.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Medicine > Warwick Medical School > Metabolic and Vascular Health Faculty of Medicine > Warwick Medical School
Journal or Publication Title:	American Journal of Hypertension
Publisher:	Nature Publishing Group
ISSN:	0895-7061
Date:	September 2010
Volume:	Vol.23
Number:	No.9
Number of Pages:	8
Page Range:	pp. 1023-1030
Identification Number:	10.1038/ajh.2010.105
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	Pfizer Inc., New York, NY, Servier Research Group, Paris, France, NIHR Biomedical Research Centre, St Mary's charitable trust
URI:	http://wrap.warwick.ac.uk/id/eprint/5254

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