Comparative Antihypertensive Efficacy of Angiotensin Receptor Blocker‐Based Treatment in African‐American and White Patients

Blood pressure (BP) reuctions with agents that block the renin‐angiotensin system are regarded as less effective as monotherapy in African Americans than other ethnic groups. This practice‐based study compares the efficacy of an angiotensin receptor blocker‐based regimen in African‐American and Caucasian patients. Included in the 10‐week study were 173 African‐American and 1296 Caucasian patients. Efficacy was based on differences in 24‐hour ambulatory BP. After baseline ambulatory BP monitoring and office BPs were obtained, all patients were started or switched to the angiotensin receptor blocker telmisartan, 40–80 mg daily, plus hydro‐chlorothiazide 12.5 mg daily (if needed for office BP control: <140/90 mm Hg). More African Americans required the addition of a low‐dose thiazide diuretic than Caucasians (47.3% vs. 34.9%; p= 0.021). Once patients with white coat hypertension were excluded (i.e., those with baseline ambulatory BP monitoring <130/80 mm Hg), ambulatory BP monitoring changes were similar between groups. A greater proportion of African Americans than Caucasians without white coat hypertension also needed combination therapy (52.1% vs. 39.5%; p= 0.04). While achievement of BP goal was similar between groups by office criterion (<140/90 mm Hg), differences were noted by ambulatory BP monitoring (<130/80 mm Hg) (48.0% in African American vs. 63.2% in Caucasians; p= 0.01) despite the same BP reductions, reflecting higher baseline values in African Americans. We conclude that an angiotensin receptor blocker as part of a BP‐lower‐ing strategy is effective in previously untreated African‐American patients, although a higher proportion will require the use of a diuretic compared with Caucasians.