Comparison of Dual Therapies for Lowering Blood Pressure in Black Africans
Dike B Ojji, Bongani Mayosi, Veronica Francis, Motasim Badri, Victoria Cornelius, Wynand Smythe, Nicky Kramer, Felix Barasa, Albertino Damasceno, Anastase Dzudie, Erika Jones, Charles Mondo, Okechukwu Ogah, Elijah Ogola, Mahmoud U Sani, Gabriel L Shedul, Grace Shedul, Brian Rayner, Ikechi G Okpechi, Karen Sliwa, Neil Poulter, CREOLE Study Investigators, G Shedul, H Eze, R Asuku, G Hanson, H Abubakar, N Baamlong, J Abu, N Egenti, M Nwegbu, M Adikwu, F Anumah, M U Sani, S A Kana, A K Suleiman, K Ibrahim, I Lawan, O Ogah, A Aje, A Adedapo, A M Ogunbode, T Ilori, A M Obimakinde, R O Akinjo, F Barasa, N Kirui, E N Ogola, E Karari, A Dzudie, E P Vanes, A Ako, S Abang, A Nzali-Feuzeu, C Mondo, P M Ingabare, E Jones, I Okpechi, B Rayner, G Ogunbanju, A Damasceno, A Fabula, P Mntla, G Ogunbanjo, D Ojji, N Poulter, B M Mayosi, V Francis, M Badri, A Dzudzie, M Sani, E Ogola, N Kramer, K Sliwa, Dike B Ojji, Bongani Mayosi, Veronica Francis, Motasim Badri, Victoria Cornelius, Wynand Smythe, Nicky Kramer, Felix Barasa, Albertino Damasceno, Anastase Dzudie, Erika Jones, Charles Mondo, Okechukwu Ogah, Elijah Ogola, Mahmoud U Sani, Gabriel L Shedul, Grace Shedul, Brian Rayner, Ikechi G Okpechi, Karen Sliwa, Neil Poulter, CREOLE Study Investigators, G Shedul, H Eze, R Asuku, G Hanson, H Abubakar, N Baamlong, J Abu, N Egenti, M Nwegbu, M Adikwu, F Anumah, M U Sani, S A Kana, A K Suleiman, K Ibrahim, I Lawan, O Ogah, A Aje, A Adedapo, A M Ogunbode, T Ilori, A M Obimakinde, R O Akinjo, F Barasa, N Kirui, E N Ogola, E Karari, A Dzudie, E P Vanes, A Ako, S Abang, A Nzali-Feuzeu, C Mondo, P M Ingabare, E Jones, I Okpechi, B Rayner, G Ogunbanju, A Damasceno, A Fabula, P Mntla, G Ogunbanjo, D Ojji, N Poulter, B M Mayosi, V Francis, M Badri, A Dzudzie, M Sani, E Ogola, N Kramer, K Sliwa
Abstract
Background: The prevalence of hypertension among black African patients is high, and these patients usually need two or more medications for blood-pressure control. However, the most effective two-drug combination that is currently available for blood-pressure control in these patients has not been established.
Methods: In this randomized, single-blind, three-group trial conducted in six countries in sub-Saharan Africa, we randomly assigned 728 black patients with uncontrolled hypertension (≥140/90 mm Hg while the patient was not being treated or was taking only one antihypertensive drug) to receive a daily regimen of 5 mg of amlodipine plus 12.5 mg of hydrochlorothiazide, 5 mg of amlodipine plus 4 mg of perindopril, or 4 mg of perindopril plus 12.5 mg of hydrochlorothiazide for 2 months. Doses were then doubled (10 and 25 mg, 10 and 8 mg, and 8 and 25 mg, respectively) for an additional 4 months. The primary end point was the change in the 24-hour ambulatory systolic blood pressure between baseline and 6 months.
Results: The mean age of the patients was 51 years, and 63% were women. Among the 621 patients who underwent 24-hour blood-pressure monitoring at baseline and at 6 months, those receiving amlodipine plus hydrochlorothiazide and those receiving amlodipine plus perindopril had a lower 24-hour ambulatory systolic blood pressure than those receiving perindopril plus hydrochlorothiazide (between-group difference in the change from baseline, -3.14 mm Hg; 95% confidence interval [CI], -5.90 to -0.38; P = 0.03; and -3.00 mm Hg; 95% CI, -5.8 to -0.20; P = 0.04, respectively). The difference between the group receiving amlodipine plus hydrochlorothiazide and the group receiving amlodipine plus perindopril was -0.14 mm Hg (95% CI, -2.90 to 2.61; P=0.92). Similar differential effects on office and ambulatory diastolic blood pressures, along with blood-pressure control and response rates, were apparent among the three groups.
Conclusions: These findings suggest that in black patients in sub-Saharan Africa, amlodipine plus either hydrochlorothiazide or perindopril was more effective than perindopril plus hydrochlorothiazide at lowering blood pressure at 6 months. (Funded by GlaxoSmithKline Africa Noncommunicable Disease Open Lab; CREOLE ClinicalTrials.gov number, NCT02742467.).
Copyright © 2019 Massachusetts Medical Society.
Source: PubMed