Regional and racial differences in response to antihypertensive medicationuse in a randomized controlled trial of men with hypertension in the United States

Citation
Wc. Cushman et al., Regional and racial differences in response to antihypertensive medicationuse in a randomized controlled trial of men with hypertension in the United States, ARCH IN MED, 160(6), 2000, pp. 825-831
Citations number
21
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
ARCHIVES OF INTERNAL MEDICINE
ISSN journal
00039926 → ACNP
Volume
160
Issue
6
Year of publication
2000
Pages
825 - 831
Database
ISI
SICI code
0003-9926(20000327)160:6<825:RARDIR>2.0.ZU;2-G
Abstract
Background: Stroke incidence and mortality rates are higher in the southeas tern region of the United States, which is called the "Stroke Belt." We com pared the response to antihypertensive medication use in patients from diff erent US regions. Methods: The short-term and 1-year efficacy of the antihypertensive medicat ions hydrochlorothiazide, atenolol, diltiazem hydrochloride (sustained rele ase), captopril, prazosin hydrochloride, and clonidine was compared by US r egion in a randomized controlled trial of 1105 men with hypertension from 1 5 US Veterans Affairs medical centers. Results: Compared with patients outside the Stroke Belt, patients inside th e Stroke Belt achieved significantly lower treatment success rates of diast olic blood pressure control at 1 year with hydrochlorothiazide (63% vs 41%) , atenolol (62% vs 46%), captopril (60% vs 30%), and clonidine (69% vs 43%) ; there were no differences in treatment success rates with diltiazem (70% vs 71%) or prazosin (54% vs 53%). When controlling for race, patients insid e the Stroke Belt had significantly lower treatment success rates with hydr ochlorothiazide (P = .003) and clonidine (P = .003), and the lower success rate with atenolol approached significance (P = .15). Regardless of region, blacks were less likely than whites to achieve treatment success with aten olol (P = .02) or prazosin (P = .03) and more likely with diltiazem (P = .0 5). There was a trend for blacks residing inside the Stroke Belt to have a lower treatment success rate than other race-region groups when treated wit h captopril (P = .07). Many regional and racial differences in diet, lifest yle, and other characteristics were observed. After adjustment for these ch aracteristics by regression analysis, the effect of residing inside the Str oke Belt remained for captopril (P = .01) and clonidine (P = .01) and appro ached significance for hydrochlorothiazide (P = .10). Conclusions: Hypertension in patients residing inside the Stroke Belt respo nded less to the use of several antihypertensive medications and important differences were shown in a number of characteristics that may affect the c ontrol of blood pressure, compared with patients residing outside the Strok e Belt.