Effect of Three Two-Drug Combinations of Antihypertensive Therapies on BP Variability in Black African Patients
TAKE-HOME MESSAGE
- In this secondary analysis of the CREOLE trial involving 405 Black African participants with hypertension, treatment with a calcium channel blocker (CCB) in combination with thiazide was associated with significant reductions in ambulatory systolic and diastolic blood pressure variability compared with treatment using a combination of an ACE inhibitor with thiazide, whereas blood pressure variability was comparable between those treated with a CCB plus thiazide and those treated with a CCB plus an ACE inhibitor.
- These findings suggest that CCB-containing combinations of dual antihypertensive therapies may be most effective for blood pressure reduction in Black patients of African descent.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
The effect of 3 commonly recommended combinations of anti-hypertensive agents-amlodipine plus hydrochlorothiazide (calcium channel blocker [CCB]+thiazide), amlodipine plus perindopril (CCB+ACE [angiotensin-converting enzyme]-inhibitor), and perindopril plus hydrochlorothiazide (ACE-inhibitor+thiazide) on blood pressure variability (V) are unknown.
METHODS
We calculated the blood pressure variability (BPV) in 405 patients (130, 146, and 129 randomized to ACE-inhibitor+thiazide, CCB+thiazide, and CCB+ACE-inhibitor, respectively) who underwent ambulatory blood pressure monitoring after 6 months of treatment in the CREOLE trial of Black African patients. BPV was calculated using the SD of 30-minute interval values for 24-hour ambulatory BPs and for confirmation using the coefficient of variation. Linear mixed model regression was used to calculate mean differences in BPV between treatment arms. Within-clinic BPV was also calculated from the mean SD and coefficient of variation of 3 readings at clinic visits.
RESULTS
Baseline distributions of age, sex, and blood pressure parameters were similar across treatment groups. Participants were predominately male (62.2%) with mean age 50.4 years. Those taking CCB+thiazide had significantly reduced ambulatory systolic and diastolic BPV compared with those taking ACE-inhibitor+thiazide. The CCB+thiazide and CCB+ACE-inhibitor groups showed similar BPV. Similar patterns of BPV were apparent among groups using within-clinic blood pressures and when assessed by coefficient of variation.
CONCLUSIONS
Compared with CCB-containing combinations, ACE-inhibitor plus thiazide was associated with higher levels, generally significant, of ambulatory and within-clinic systolic and diastolic BPV. These results supplement the differential ambulatory blood pressure-lowering effects of these therapies in the CREOLE trial.
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Additional Info
Disclosure statements are available on the authors' profiles:
Effect of 3, 2-Drug Combinations of Antihypertensive Therapies on Blood Pressure Variability in Black African Patients: Secondary Analyses of the CREOLE Trial
Hypertension 2022 Sep 02;[EPub Ahead of Print], DB Ojji, V Cornelius, G Partington, V Francis, S Pandie, W Smythe, N Hickman, F Barasa, A Damasceno, A Dzudie, E Jones, PM Ingabire, C Mondo, O Ogah, E Ogola, MU Sani, GL Shedul, G Shedul, B Rayner, K Sliwa, N PoulterFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
In this analysis of the CREOLE trial, the authors studied the impact of three different combinations of antihypertensive therapies on blood pressure (BP) variability among Black adults residing in sub-Saharan Africa. The burden of hypertension in this part of the world is incredible, so this analysis is potentially quite important clinically. The authors defined BP variability over 24 hours using an ambulatory monitor and also over three study visits using office BP measurement. They found that the ACE inhibitor plus thiazide combination (perindopril plus hydrochlorothiazide) was the worst in terms of high on-treatment residual BP variability in these patients. Because BP variability tends to be associated with adverse events, this suggests that the ACE inhibitor plus thiazide combination may be best avoided (compared with the other two combinations studied) in these patients. However, it is hard to state this suggestion with any certainty, since this study is a post hoc, non-prespecified analysis of a randomized trial of BP levels which did not include an analysis of clinical events.