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