Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks
Abstract Background Angiotensin-converting enzyme inhibitors are used widely in the treatment of patients with hypertension. However, their efficacy in hypertensive blacks when compared with other antihypertensive agents is not well established. Methods We performed a cohort study of patients using...
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| Veröffentlicht in: | The American journal of medicine 2015-11, Vol.128 (11), p.1195-1203 |
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| creator | Bangalore, Sripal, MD, MHA Ogedegbe, Gbenga, MD, MS, MPH Gyamfi, Joyce, MS Guo, Yu, MA Roy, Jason, PhD Goldfeld, Keith, DrPH Torgersen, Christopher, MBA Capponi, Louis, MD Phillips, Christopher, MD, MPH Shah, Nirav R., MD, MPH |
| description | Abstract Background Angiotensin-converting enzyme inhibitors are used widely in the treatment of patients with hypertension. However, their efficacy in hypertensive blacks when compared with other antihypertensive agents is not well established. Methods We performed a cohort study of patients using data from a clinical data warehouse of 434,646 patients from New York City's Health and Hospitals Corporation from January 2004 to December 2009. Patients were divided into the following comparison groups: angiotensin-converting enzyme inhibitors vs calcium channel blockers, angiotensin-converting enzyme inhibitors vs thiazide diuretics, and angiotensin-converting enzyme inhibitors vs β-blockers. The primary outcome was a composite of death, myocardial infarction, and stroke. Secondary outcomes included the individual components and heart failure. Results In the propensity score-matched angiotensin-converting enzyme inhibitors vs calcium channel blocker comparison cohort (4506 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.19-1.77; P = .0003), myocardial infarction (HR, 3.40; 95% CI, 1.25-9.22; P = .02), stroke (HR, 1.82; 95% CI, 1.29-2.57; P = .001), and heart failure (HR, 1.77; 95% CI, 1.30-2.42; P = .0003) when compared with calcium channel blockers. For the angiotensin-converting enzyme inhibitors vs thiazide diuretics comparison (5337 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (HR, 1.65; 95% CI, 1.33-2.05; P < .0001), death (HR, 1.35; 95% CI, 1.03-1.76; P = .03), myocardial infarction (HR, 4.00; 95% CI, 1.34-11.96; P = .01), stroke (HR, 1.97; 95% CI, 1.34-2.92; P = .001), and heart failure (HR, 3.00; 95% CI, 1.99-4.54; P < .0001). For the angiotensin-converting enzyme inhibitors vs β-blocker comparison, the outcomes between the groups were not significantly different. Conclusions In a real-world cohort of hypertensive blacks, angiotensin-converting enzyme inhibitors were associated with a higher risk of cardiovascular events when compared with calcium channel blockers or thiazide diuretics. |
| doi_str_mv | 10.1016/j.amjmed.2015.04.034 |
| format | Article |
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However, their efficacy in hypertensive blacks when compared with other antihypertensive agents is not well established. Methods We performed a cohort study of patients using data from a clinical data warehouse of 434,646 patients from New York City's Health and Hospitals Corporation from January 2004 to December 2009. Patients were divided into the following comparison groups: angiotensin-converting enzyme inhibitors vs calcium channel blockers, angiotensin-converting enzyme inhibitors vs thiazide diuretics, and angiotensin-converting enzyme inhibitors vs β-blockers. The primary outcome was a composite of death, myocardial infarction, and stroke. Secondary outcomes included the individual components and heart failure. Results In the propensity score-matched angiotensin-converting enzyme inhibitors vs calcium channel blocker comparison cohort (4506 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.19-1.77; P = .0003), myocardial infarction (HR, 3.40; 95% CI, 1.25-9.22; P = .02), stroke (HR, 1.82; 95% CI, 1.29-2.57; P = .001), and heart failure (HR, 1.77; 95% CI, 1.30-2.42; P = .0003) when compared with calcium channel blockers. For the angiotensin-converting enzyme inhibitors vs thiazide diuretics comparison (5337 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (HR, 1.65; 95% CI, 1.33-2.05; P < .0001), death (HR, 1.35; 95% CI, 1.03-1.76; P = .03), myocardial infarction (HR, 4.00; 95% CI, 1.34-11.96; P = .01), stroke (HR, 1.97; 95% CI, 1.34-2.92; P = .001), and heart failure (HR, 3.00; 95% CI, 1.99-4.54; P < .0001). For the angiotensin-converting enzyme inhibitors vs β-blocker comparison, the outcomes between the groups were not significantly different. Conclusions In a real-world cohort of hypertensive blacks, angiotensin-converting enzyme inhibitors were associated with a higher risk of cardiovascular events when compared with calcium channel blockers or thiazide diuretics.</description><identifier>ISSN: 0002-9343</identifier><identifier>EISSN: 1555-7162</identifier><identifier>DOI: 10.1016/j.amjmed.2015.04.034</identifier><identifier>PMID: 26071821</identifier><identifier>CODEN: AJMEAZ</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>ACE inhibitors ; Adult ; African Americans ; Aged ; Angiotensin-converting enzyme inhibitors ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Antihypertensive Agents - therapeutic use ; Black people ; Blacks ; Cardiovascular disease ; Comparative analysis ; Drug therapy ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Hypertension - complications ; Hypertension - drug therapy ; Hypertension - ethnology ; Hypertension - mortality ; Internal Medicine ; Male ; Middle Aged ; Myocardial Infarction - ethnology ; Myocardial Infarction - etiology ; Myocardial Infarction - mortality ; Myocardial Infarction - prevention & control ; New York City ; Stroke - ethnology ; Stroke - etiology ; Stroke - mortality ; Stroke - prevention & control ; Treatment Outcome</subject><ispartof>The American journal of medicine, 2015-11, Vol.128 (11), p.1195-1203</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Nov 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c561t-13f31d1addd9de7e7d4d37b23b86abbf2853f514a8f4e5968aab19d496436b4c3</citedby><cites>FETCH-LOGICAL-c561t-13f31d1addd9de7e7d4d37b23b86abbf2853f514a8f4e5968aab19d496436b4c3</cites><orcidid>0000-0001-9485-0652</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002934315004453$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26071821$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bangalore, Sripal, MD, MHA</creatorcontrib><creatorcontrib>Ogedegbe, Gbenga, MD, MS, MPH</creatorcontrib><creatorcontrib>Gyamfi, Joyce, MS</creatorcontrib><creatorcontrib>Guo, Yu, MA</creatorcontrib><creatorcontrib>Roy, Jason, PhD</creatorcontrib><creatorcontrib>Goldfeld, Keith, DrPH</creatorcontrib><creatorcontrib>Torgersen, Christopher, MBA</creatorcontrib><creatorcontrib>Capponi, Louis, MD</creatorcontrib><creatorcontrib>Phillips, Christopher, MD, MPH</creatorcontrib><creatorcontrib>Shah, Nirav R., MD, MPH</creatorcontrib><title>Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks</title><title>The American journal of medicine</title><addtitle>Am J Med</addtitle><description>Abstract Background Angiotensin-converting enzyme inhibitors are used widely in the treatment of patients with hypertension. However, their efficacy in hypertensive blacks when compared with other antihypertensive agents is not well established. Methods We performed a cohort study of patients using data from a clinical data warehouse of 434,646 patients from New York City's Health and Hospitals Corporation from January 2004 to December 2009. Patients were divided into the following comparison groups: angiotensin-converting enzyme inhibitors vs calcium channel blockers, angiotensin-converting enzyme inhibitors vs thiazide diuretics, and angiotensin-converting enzyme inhibitors vs β-blockers. The primary outcome was a composite of death, myocardial infarction, and stroke. Secondary outcomes included the individual components and heart failure. Results In the propensity score-matched angiotensin-converting enzyme inhibitors vs calcium channel blocker comparison cohort (4506 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.19-1.77; P = .0003), myocardial infarction (HR, 3.40; 95% CI, 1.25-9.22; P = .02), stroke (HR, 1.82; 95% CI, 1.29-2.57; P = .001), and heart failure (HR, 1.77; 95% CI, 1.30-2.42; P = .0003) when compared with calcium channel blockers. For the angiotensin-converting enzyme inhibitors vs thiazide diuretics comparison (5337 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (HR, 1.65; 95% CI, 1.33-2.05; P < .0001), death (HR, 1.35; 95% CI, 1.03-1.76; P = .03), myocardial infarction (HR, 4.00; 95% CI, 1.34-11.96; P = .01), stroke (HR, 1.97; 95% CI, 1.34-2.92; P = .001), and heart failure (HR, 3.00; 95% CI, 1.99-4.54; P < .0001). For the angiotensin-converting enzyme inhibitors vs β-blocker comparison, the outcomes between the groups were not significantly different. Conclusions In a real-world cohort of hypertensive blacks, angiotensin-converting enzyme inhibitors were associated with a higher risk of cardiovascular events when compared with calcium channel blockers or thiazide diuretics.</description><subject>ACE inhibitors</subject><subject>Adult</subject><subject>African Americans</subject><subject>Aged</subject><subject>Angiotensin-converting enzyme inhibitors</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Black people</subject><subject>Blacks</subject><subject>Cardiovascular disease</subject><subject>Comparative analysis</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - complications</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - ethnology</subject><subject>Hypertension - mortality</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - ethnology</subject><subject>Myocardial Infarction - etiology</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - prevention & control</subject><subject>New York City</subject><subject>Stroke - ethnology</subject><subject>Stroke - etiology</subject><subject>Stroke - mortality</subject><subject>Stroke - prevention & control</subject><subject>Treatment Outcome</subject><issn>0002-9343</issn><issn>1555-7162</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks1u1DAUhS0EokPhDRCKxIZNgv-TbJCGqtBKlWYBrC3HvpnxNHEG2xk0PD2OphWoG1aWfb9z7OtzEXpLcEUwkR_3lR73I9iKYiIqzCvM-DO0IkKIsiaSPkcrjDEtW8bZBXoV4z5vcSvkS3RBJa5JQ8kK-c2czDRCLH65tCvWfuumBD46X5rJHyEk57fFtf99GqG49TvXuTSFWBxjsUk7CFmR3O50yOCiOkKx3oJPsXC-uPn3-POgzX18jV70eojw5mG9RD--XH-_uinvNl9vr9Z3pRGSpJKwnhFLtLW2tVBDbblldUdZ10jddT1tBOsF4brpOYhWNlp3pLW8lZzJjht2iT6cfQ9h-jlDTGp00cAwaA_THBWpad02ggqZ0fdP0P00B59flykmGeOU40zxM2XCFGOAXh2CG3U4KYLVkofaq3MeaslDYa5yHln27sF87pbao-gxgAx8OgOQf-PoIKhoHHgD1gUwSdnJ_e-GpwZmcN4ZPdzDCeLfXlSkCqtvy0wsI0EExpwLxv4AKjW0Cg</recordid><startdate>20151101</startdate><enddate>20151101</enddate><creator>Bangalore, Sripal, MD, MHA</creator><creator>Ogedegbe, Gbenga, MD, MS, MPH</creator><creator>Gyamfi, Joyce, MS</creator><creator>Guo, Yu, MA</creator><creator>Roy, Jason, PhD</creator><creator>Goldfeld, Keith, DrPH</creator><creator>Torgersen, Christopher, MBA</creator><creator>Capponi, Louis, MD</creator><creator>Phillips, Christopher, MD, MPH</creator><creator>Shah, Nirav R., MD, MPH</creator><general>Elsevier Inc</general><general>Elsevier Sequoia S.A</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9485-0652</orcidid></search><sort><creationdate>20151101</creationdate><title>Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks</title><author>Bangalore, Sripal, MD, MHA ; Ogedegbe, Gbenga, MD, MS, MPH ; Gyamfi, Joyce, MS ; Guo, Yu, MA ; Roy, Jason, PhD ; Goldfeld, Keith, DrPH ; Torgersen, Christopher, MBA ; Capponi, Louis, MD ; Phillips, Christopher, MD, MPH ; Shah, Nirav R., MD, MPH</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c561t-13f31d1addd9de7e7d4d37b23b86abbf2853f514a8f4e5968aab19d496436b4c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>ACE inhibitors</topic><topic>Adult</topic><topic>African Americans</topic><topic>Aged</topic><topic>Angiotensin-converting enzyme inhibitors</topic><topic>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Black people</topic><topic>Blacks</topic><topic>Cardiovascular disease</topic><topic>Comparative analysis</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - complications</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - ethnology</topic><topic>Hypertension - mortality</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - ethnology</topic><topic>Myocardial Infarction - etiology</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - prevention & control</topic><topic>New York City</topic><topic>Stroke - ethnology</topic><topic>Stroke - etiology</topic><topic>Stroke - mortality</topic><topic>Stroke - prevention & control</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bangalore, Sripal, MD, MHA</creatorcontrib><creatorcontrib>Ogedegbe, Gbenga, MD, MS, MPH</creatorcontrib><creatorcontrib>Gyamfi, Joyce, MS</creatorcontrib><creatorcontrib>Guo, Yu, MA</creatorcontrib><creatorcontrib>Roy, Jason, PhD</creatorcontrib><creatorcontrib>Goldfeld, Keith, DrPH</creatorcontrib><creatorcontrib>Torgersen, Christopher, MBA</creatorcontrib><creatorcontrib>Capponi, Louis, MD</creatorcontrib><creatorcontrib>Phillips, Christopher, MD, MPH</creatorcontrib><creatorcontrib>Shah, Nirav R., MD, MPH</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bangalore, Sripal, MD, MHA</au><au>Ogedegbe, Gbenga, MD, MS, MPH</au><au>Gyamfi, Joyce, MS</au><au>Guo, Yu, MA</au><au>Roy, Jason, PhD</au><au>Goldfeld, Keith, DrPH</au><au>Torgersen, Christopher, MBA</au><au>Capponi, Louis, MD</au><au>Phillips, Christopher, MD, MPH</au><au>Shah, Nirav R., MD, MPH</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks</atitle><jtitle>The American journal of medicine</jtitle><addtitle>Am J Med</addtitle><date>2015-11-01</date><risdate>2015</risdate><volume>128</volume><issue>11</issue><spage>1195</spage><epage>1203</epage><pages>1195-1203</pages><issn>0002-9343</issn><eissn>1555-7162</eissn><coden>AJMEAZ</coden><abstract>Abstract Background Angiotensin-converting enzyme inhibitors are used widely in the treatment of patients with hypertension. However, their efficacy in hypertensive blacks when compared with other antihypertensive agents is not well established. Methods We performed a cohort study of patients using data from a clinical data warehouse of 434,646 patients from New York City's Health and Hospitals Corporation from January 2004 to December 2009. Patients were divided into the following comparison groups: angiotensin-converting enzyme inhibitors vs calcium channel blockers, angiotensin-converting enzyme inhibitors vs thiazide diuretics, and angiotensin-converting enzyme inhibitors vs β-blockers. The primary outcome was a composite of death, myocardial infarction, and stroke. Secondary outcomes included the individual components and heart failure. Results In the propensity score-matched angiotensin-converting enzyme inhibitors vs calcium channel blocker comparison cohort (4506 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.19-1.77; P = .0003), myocardial infarction (HR, 3.40; 95% CI, 1.25-9.22; P = .02), stroke (HR, 1.82; 95% CI, 1.29-2.57; P = .001), and heart failure (HR, 1.77; 95% CI, 1.30-2.42; P = .0003) when compared with calcium channel blockers. For the angiotensin-converting enzyme inhibitors vs thiazide diuretics comparison (5337 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (HR, 1.65; 95% CI, 1.33-2.05; P < .0001), death (HR, 1.35; 95% CI, 1.03-1.76; P = .03), myocardial infarction (HR, 4.00; 95% CI, 1.34-11.96; P = .01), stroke (HR, 1.97; 95% CI, 1.34-2.92; P = .001), and heart failure (HR, 3.00; 95% CI, 1.99-4.54; P < .0001). For the angiotensin-converting enzyme inhibitors vs β-blocker comparison, the outcomes between the groups were not significantly different. Conclusions In a real-world cohort of hypertensive blacks, angiotensin-converting enzyme inhibitors were associated with a higher risk of cardiovascular events when compared with calcium channel blockers or thiazide diuretics.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26071821</pmid><doi>10.1016/j.amjmed.2015.04.034</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-9485-0652</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | ACE inhibitors Adult African Americans Aged Angiotensin-converting enzyme inhibitors Angiotensin-Converting Enzyme Inhibitors - therapeutic use Antihypertensive Agents - therapeutic use Black people Blacks Cardiovascular disease Comparative analysis Drug therapy Female Follow-Up Studies Humans Hypertension Hypertension - complications Hypertension - drug therapy Hypertension - ethnology Hypertension - mortality Internal Medicine Male Middle Aged Myocardial Infarction - ethnology Myocardial Infarction - etiology Myocardial Infarction - mortality Myocardial Infarction - prevention & control New York City Stroke - ethnology Stroke - etiology Stroke - mortality Stroke - prevention & control Treatment Outcome |
| title | Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks |
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