Clinical Health Updates

Little information on racial differences between antihypertensives

Clinical Question:
Are there racial differences in response to antihypertensive medications?

Bottom Line:
There are few high-quality studies of different antihypertensive medications that compare clinical outcomes of patients across different racial and ethnic groups. Most of the existing studies find no difference in outcomes between white and nonwhite patients.

Park IU, Taylor AL. Race and ethnicity in trials of antihypertensive therapy to prevent cardiovascular outcomes: a systematic review. Ann Fam Med. 2007;5(5):444-452.

Study Design:
Systematic review

These authors systematically reviewed multiple databases looking for clinical trials of antihypertensive medications that compared treatment response among patients of different racial groups and ethnicities. The searches were supplemented by hand-searching reference lists of other systematic reviews and practice guidelines, and by speaking with experts, but the authors don’t describe looking for unpublished data. They excluded studies that did not report clinically important outcomes like mortality or cardiovascular events. Two authors independently determined if studies were to be included in this review and they resolved disagreements by consensus. The authors then extracted data on race, ethnicity, and outcomes from each trial. Finally, they contacted the original study authors to obtain missing information. Of the 28 studies making the final cut, only 8 described outcomes in nonwhite patients and only 5 compared outcomes across groups. The quality scores of the studies ranged from 3 to 5, using the Jadad score (range = 0 – 5). Given the variability in inclusion criteria, follow-up duration, treatments, and so forth, the authors appropriately refrained form pooling the results. Of the 5 studies comparing outcomes across ethnic and racial groups, 4 found no difference in outcomes. Only ALLHAT (JAMA 2002;288(23):2981-2997) found blacks experienced greater benefits from diuretics than nonblack patients.