September 14, 2015
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ACE inhibitors linked to poor CV outcomes in hypertensive black adults

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Black adults with hypertension treated with ACE inhibitors had an increased risk for all-cause mortality, stroke and acute MI compared with white adults, according to results of a recent study.

Researchers retrospectively studied 59,316 black and white adults with hypertension enrolled in a municipal health care system in New York. Patients were divided into groups based on race and whether they had received treatment with ACE inhibitors or other therapies such as beta-blockers, thiazide-type diuretics or calcium channel blockers for 6 months or longer after enrollment in the health care system.

The primary outcome was a composite of all-cause mortality, stroke and acute MI.

During a mean follow-up of 4.5 years, the researchers observed an interaction between race and treatment response (P = .04). The primary composite outcome occurred more frequently among black adults who were treated with ACE inhibitors compared with other therapies (8.69% vs. 7.74%; P = .05). The same interaction was not observed among white adults based on ACE inhibitor use or another regimen (6.4% vs. 6.74%; P = .37).

Analysis of individual components of the primary outcome indicated that black adults treated with ACE inhibitors had higher rates of acute MI (0.46% vs. 0.26%; P = .04), stroke (2.43% vs. 1.93%; P = .05) and congestive HF (3.75% vs. 2.25%; P = .0001) compared with black adults treated with other therapies. Among white adults, only all-cause mortality differed significantly between users and nonusers of ACE inhibitors, with reduced risk observed among users (HR = 0.87; 95% CI, 0.76-1).

ACE inhibitor users had similar rates of hyperkalemia and hypokalemia regardless of race, the researchers wrote.

“These findings confirm clinical trial evidence that hypertensive black patients have poorer outcomes than whites when treated with an ACE inhibitor-based regimen,” the researchers concluded.

Richard J. Kovacs, MD, FACC

Richard J. Kovacs

In a related editorial, Richard J. Kovacs, MD, noted that black adults who were receiving monotherapy with ACE inhibitors could have been treated with other antihypertensive drugs, preventing several cases of stroke, MI or HF with little to no additional cost.

“Comparing the effectiveness and safety of antihypertensive drugs in real-world practice empowers a large system of care to make changes that will prevent adverse events,” Kovacs, from the Krannert Institute of Cardiology, Indiana University School of Medicine/Indiana University Health, wrote. “The opportunity to improve outcomes is staggering.” – by Adam Taliercio

Disclosure: Ogedegbe reports receiving a grant from the NHLBI. Another researcher reports receiving honoraria from Abbott, Boehringer Ingelheim, Daiichi Sankyo, Gilead, Merck and Pfizer. Kovacs reports no relevant financial disclosures.