First-line antihypertensives show little efficacy variation by age, ethnicity

  • Sinnott SJ & al.
  • BMJ
  • 18.11.2020

  • von Emily Willingham, PhD
  • Clinical Essentials
Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten. Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten.

Takeaway

  • Antihypertensive medications perform about the same regardless of age or ethnicity.
  • People over age 75 years may experience steeper BP reductions with calcium channel blockers (CCBs) vs angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs).
  • A numeric difference in drug effects between Black and non-Black people without diabetes did not meet statistical significance.

Why this matters

  • These authors were examining UK treatment recommendations that are based on age and ethnicity and say that these factors might not be the best drivers of drug choice.
  • They suggest urinary protein loss as a possible criterion.

Key results

  • They included data for 87,440 new ACEI/ARB users; 67,274 new CCB users; and 22,040 new thiazide users.
  • Systolic BP changes did not differ significantly below or at/above an age threshold of 55 years for any of the drugs.
  • Stratification by ethnicity (Black or non-Black) also revealed no significant differences.
  • Patterns at 12 weeks persisted at 1 year.
  • Findings for diastolic BP were similar.
  • The one significant finding was a steeper systolic BP decrease in non-Black people age 75+ years taking CCBs vs ACEIs/ARBs.

Study design

  • Observational cohort study in UK primary cares, January 1, 2007-December 31, 2017.
  • Funding: Author funding cited.

Limitations

  • Drugs may have been prescribed for nonhypertension indications.
  • Observational, residual confounding likely.