Low-dose combination therapy as first-line hypertension treatment for blacks and nonblacks

To assess the efficacy and safety of bisoprolol/6.25-mg hydrochlorothiazide (HCTZ), amlodipine, and enalapril in black and nonblack patients, data fro m two comparative studies were pooled and subgroup analyses performed. Both studies had similar designs and included all three active treatments. The second study also included a placebo group. Subjects (n=541) with a sitting diastolic blood pressure of 95-114 mmHg were titrated to achieve a diastol ic blood pressure less than or equal to 90 mmHg. The studies included 114 b lacks and 427 nonblocks. Results of an intention-to-treat analysis of mean change from baseline afte r 12 weeks of treatment showed the following: 1) blood pressure was signifi cantly towered by all three active drugs compared with baseline or placebo; 2) in blacks, bisoprolol/6.25-mg HCTZ resulted in significantly greater re ductions of systolic and diastolic blood pressure than enalapril or placebo , but was not significantly different from amlodipine; 3) in nonblacks, bis oprolol/6.25-mg HCTZ resulted in significantly greater reduction of diastol ic blood pressure than amlodipine, enalapril, or placebo. The placebo-corre cted change in blood pressure was greater for blacks than whites on the bis oprolol/6.25-mg HCTZ combination, but this was not statistically significan t. Bisoprolol/6.25-mg HCTZ controlled diastolic blood pressure to less than or equal to 90 mmHg in significantly more patients than enalapril or place bo in blacks and nonblocks. The difference in control rates was not signifi cant versus amlodipine. The incidence of drug-related adverse events was si milar between treatments; however, bisoprolol/6.25-mg HCTZ had a lower disc ontinuation rate due to lack of blood pressure control or adverse experienc es in both blacks and nonblacks.