MIAMI BEACH – Just slightly more than half of black patients with hypertension attained their systolic and diastolic blood pressure goals at 1 year in a large, cross-sectional study, which suggests that more aggressive intervention is needed.
"There is a perception among some ... that hypertension is not an issue, that patients are well controlled. The ultimate goal of this research is to vet that," Michael Hagan, Dr.P.H., said at a meeting sponsored by the International Society on Hypertension in Blacks.
Another prominent finding is that combination drug therapy outperformed the use of only one agent at a time, according to this General Electric electronic medical record database study of 9,251 hypertensive blacks. In addition, notable differences in efficacy emerged among 16 different treatment strategies, Dr. Hagan reported.
Despite at least 1 year of treatment, only 53% of the study subjects achieved a blood pressure goal below 140/90 mm Hg (or below 130/80 mmHg if they had diabetes or chronic kidney disease). "So far, we’ve found a large, unmet need in terms of getting patients to goal."
Goal attainment varied by therapy, with combination therapy outshining monotherapy in general. Goals were met by 67% of patients taking a beta-blocker plus diuretic, by 65% of those taking a thiazide or thiazidelike diuretic, by 57% of those taking an ACE inhibitor plus hydrochlorothiazide, by 54% of those taking a calcium channel blocker, by 51% of patients taking an angiotensin receptor blocker plus hydrochlorothiazide, by 46% of those on ACE inhibitor monotherapy, and by 45% of those prescribed an angiotensin receptor blocker alone.
The study also reveals differences in systolic and diastolic blood pressure decreases after 6 months and 1 year. "The combination of beta-blocker plus diuretic had the largest effect," said Dr. Hagan, director of global health economics and outcomes research at Takeda Pharmaceuticals North America.
At both 6 months and 1 year, patients taking a beta-blocker and diuretic experienced the greatest decrease in systolic blood pressure (about 13%) compared with baseline measures. This combination also was associated with the greatest decrease in diastolic blood pressure at 6 months (12%). Patients taking an ACE inhibitor plus hydrochlorothiazide experienced the greatest drop in diastolic pressure at 1 year (11%).
Interestingly, only 1% of the study population was prescribed the most effective combination. In contrast, 21% were prescribed the most common treatment: an ACE inhibitor. Next most common were calcium channel blockers (17%); thiazide or thiazidelike diuretics (15%); an ACE inhibitor plus hydrochlorothiazide (15%); an ARB plus hydrochlorothiazide; and an ARB alone (7%).
Overall mean baseline blood pressure was 146/87 mm Hg. A significant decrease to 132/79 mm Hg was observed at 1 year, Dr. Hagan reported.
This potential limitation stems from the retrospective, cross-sectional design of the study, which limits investigating why patients were prescribed a certain regimen, for example. Additional findings are forthcoming, Dr. Hagan added, and could include assessment of antihypertensive use and efficacy in the general hypertensive population, as well as the treatment profile of certain higher risk subgroups.
Mean patient age in the study was 58 years and 68% were women. The most prevalent risk factors for hypertension were obesity (65%), stage 2 hypertension (50%), and diabetes (43%).
Takeda Pharmaceuticals sponsored this study.