Difference in blood pressure response to ACE-Inhibitor monotherapy between black and white adults with arterial hypertension: a meta-analysis of 13 clinical trials
Difference in blood pressure response to ACE-Inhibitor monotherapy between black and white adults with arterial hypertension: a meta-analysis of 13 clinical trials
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DOI：
10.1186/1471-2369-14-201
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发表时间：
2013-09-26
期刊：
影响因子：
2.3
通讯作者：
Schmidt, Bernhard M. W.
中科院分区：
文献类型：
--
作者：
Peck, Robert N.;Smart, Luke R.;Schmidt, Bernhard M. W.
背景资料：在非洲裔美国成年人中，动脉高血压比白色成年人更普遍，并发症也更多。高血压在撒哈拉以南非洲的黑人成年人中也很流行。在黑人成年人的高血压的治疗可能是复杂的反应较小的某些类别的抗高血压agents.Methods：我们系统地搜索文献ACE抑制剂的临床试验在高血压成年人之间比较血压反应白人和黑人。进行荟萃分析，以确定收缩压和舒张压反应的差异。进一步分析，包括荟萃回归，漏斗图，和一个研究删除分析进行调查异质性或偏倚的可能来源。结果：在荟萃分析的13个试验提供了17个不同的患者组进行评估，黑人种族与收缩压降低较小（平均差异：4.6 mmHg（95% CI 3.5-5.7））和舒张压（平均差异：2.8 mmHg（95% CI 2.2-3.5））对ACE抑制剂的反应，几乎没有异质性。荟萃回归分析显示，只有ACE抑制剂剂量作为异质性的一个重要来源。几乎没有证据表明出版bias.Conclusions：黑人种族始终与ACE抑制剂治疗在美国和欧洲的临床试验中收缩压和舒张压的临床显著降低相关。在需要单药治疗无并发症高血压的黑人成年人中，可能首选ACE抑制剂以外的药物，但必须记住ACE抑制剂在某些亚组中已证实的获益以及黑人和白人之间的反应重叠。这些数据对于解释撒哈拉以南非洲高血压黑人成年人的临床药物试验以及制定该人群的治疗建议尤为重要。
Background: Among African-Americans adults, arterial hypertension is both more prevalent and associated with more complications than among white adults. Hypertension is also epidemic among black adults in sub-Saharan Africa. The treatment of hypertension among black adults may be complicated by lesser response to certain classes of anti-hypertensive agents.Methods: We systematically searched literature for clinical trials of ACE-inhibitors among hypertensive adults comparing blood pressure response between whites and blacks. Meta-analysis was performed to determine the difference in systolic and diastolic blood pressure response. Further analysis including meta-regressions, funnel plots, and one-study-removed analyses were performed to investigate possible sources of heterogeneity or bias.Results: In a meta-analysis of 13 trials providing 17 different patient groups for evaluation, black race was associated with a lesser reduction in systolic (mean difference: 4.6 mmHg (95% CI 3.5-5.7)) and diastolic (mean difference: 2.8 mmHg (95% CI 2.2-3.5)) blood pressure response to ACE-inhibitors, with little heterogeneity. Meta-regression revealed only ACE-inhibitor dosage as a significant source of heterogeneity. There was little evidence of publication bias.Conclusions: Black race is consistently associated with a clinically significant lesser reduction in both systolic and diastolic blood pressure to ACE-inhibitor therapy in clinical trials in the USA and Europe. In black adults requiring monotherapy for uncomplicated hypertension, drugs other than ACE-inhibitors may be preferred, though the proven benefits of ACE-inhibitors in some sub-groups and the large overlap of response between blacks and whites must be remembered. These data are particularly important for interpretation of clinical drug trials for hypertensive black adults in sub-Saharan Africa and for the development of treatment recommendations in this population.