FRIDAY, May 16, 2003 (HealthDayNews) -- Doctors need a combination of drugs to control hypertension in patients with coronary artery disease, says a new study that finds different races respond differently to such medications.
"It takes two to three drugs to adequately control blood pressure," says Eileen Handberg, an assistant professor of medicine and director of the clinical trial program at the University of Florida in Gainesville. "Physicians can now tailor treatment to individual patients needs using a variety of drugs."
The INVEST study (International Verapamil/Trandolapril Study) compared two treatment strategies in some 22,000 people with coronary artery disease and high blood pressure. Of the patients included in the current analysis, 7,640 were white, 1,947 blacks and 5,903 were Hispanic.
According to the report presented May 16 at the annual meeting of the American Society of Hypertension in New York City, one group received a calcium channel blocker (verapamil SR) plus an ACE inhibitor (trandolapril) and, if necessary, a diuretic (hydrochlorothiazide). The other group received a beta-blocker (atenolol), followed by hydrochlorothiazide and then trandolapril.
The blood pressure goals for the patients were a reading of 140/90, except in patients with renal disease or diabetes, where the goal was 130/85, Handberg says.
After one year, the research team found both treatment strategies were effective. Systolic (the higher figure) blood pressure control was seen in 64 percent of patients, and diastolic (the lower figure) control was achieved in 91 percent of the patients, Handberg says.
Handberg notes there was no difference between the groups in various outcomes including heart attacks, strokes or death. These results held true regardless of race, age or medical history, she adds.
While all groups achieved their blood pressure goals, many blacks required more medications at higher doses. Among Hispanics, these goals were achieved more easily than in either blacks or whites.
"This is the first time that there has been a large study of patients with coronary artery disease and hypertension. These patients present complex problems with many risk factors, and physicians need to be able to customize treatment," Handberg says.
She adds "this study shows that physicians have many options in treating these patients and achieving good hypertension control. And patients should know that blood pressure can be controlled."
Dr. Clarence Grim from the Medical College of Wisconsin disagrees with the method and conclusions of the study. It "did not start treatment with a diuretic despite the fact that other major studies recommended that this is the best way to start anti-hypertensive therapy. These studies have demonstrated that to do otherwise, especially in blacks, may result in more strokes," he comments.
"The best treatment to prevent complications from high blood pressure should not begin with a calcium channel blocker or an ACE inhibitor," Grim says. "This is especially true in blacks, in whom the sensitivity to sodium is greater than the other ethnic groups."
From the results of older studies it can be predicted that a diuretic alone will control blood pressure in half of the blacks, Grim says. He adds that several large trials have demonstrated that blacks, when started on a diuretic, do as well as whites.
Grim believes that the best way to manage high blood pressure is to teach people to take their own blood pressure, and control their diet. Then, if necessary, diuretics and other drugs should be added. The goal of treatment, he says, "is to control blood pressure with as few pills as possible."
"I have never considered it good judgment to treat blacks -- or any other group -- with any other first drug than a diuretic," Grim says. "It is cheaper and better for the patient. The INVEST study will not change my practice -- and, I hope no one else's who currently starts treatment with a diuretic."
In other findings presented at the meeting, a team led by Dr. Margaret Scisney-Matlock of the University of Michigan found that hypertensive women who monitor their blood pressure are more likely to take their medications, and thus more likely to achieve blood pressure control.
In this study, 161 women, 60 of whom were black, were assigned to home blood pressure monitoring alone or in combination with an education program. The researchers found that both groups benefited equally.
"The positive changes in blood pressures shown in this study were thought to be a result of increased sense of control or involvement required for taking anti-hypertensive medication and taking and recording blood pressures at home," Scisney-Matlock says in a statement.
The greatest difference in blood pressure control was seen among black women in the home-monitoring-only group, with an average drop in systolic blood pressure of 11.2 millimeters of mercury, compared with an average drop of 7.5 millimeters among white women.
"African-American women suffer from high blood pressure at a greater rate than white women, putting them at greater risk for stroke, heart attack and kidney failure," Scisney-Matlock says. "It doesn't have to be that way."
More information
For more on high blood pressure, visit the American Heart Association or the National Heart, Lung, and
Blood Institute.
