Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa

J R M'Buyamba-Kabangu, B C Anisiuba, M B Ndiaye, D Lemogoum, L Jacobs, C K Ijoma, L Thijs, H J Boombhi, J Kaptue, P M Kolo, J B Mipinda, C E Osakwe, A Odili, B Ezeala-Adikaibe, S Kingue, B A Omotoso, S A Ba, I I Ulasi, J A Staessen, Newer versus Older Antihypertensive Agents in African Hypertensive Patients Trial (NOAAH) Investigators, J R M'Buyamba-Kabangu, B C Anisiuba, M B Ndiaye, D Lemogoum, L Jacobs, C K Ijoma, L Thijs, H J Boombhi, J Kaptue, P M Kolo, J B Mipinda, C E Osakwe, A Odili, B Ezeala-Adikaibe, S Kingue, B A Omotoso, S A Ba, I I Ulasi, J A Staessen, Newer versus Older Antihypertensive Agents in African Hypertensive Patients Trial (NOAAH) Investigators

Abstract

To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After ≥4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (<140/<90 mm Hg), bisoprolol and amlodipine could be doubled (10 mg per day) and α-methyldopa (0.5-2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (-0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P<0.0001) systolic, 1.3 mm Hg (P=0.12) diastolic, and 9.6 beats per minute (P<0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P<0.0001) systolic, 1.8 mm Hg (P=0.07) diastolic and 9.8 beats per minute (P<0.0001). In R compared with E patients, 45 vs 37% (P=0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P<0.0001) had α-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P=0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients.

Figures

Figure 1
Figure 1
Systolic (a) and diastolic (b) blood pressures and heart rate (c) at randomisation and at various follow-up visits in patients randomised to old drugs (n=89) or new drugs (n=94). Plotted values are means±s.e. The number of patients contributing to the means is given. P-values denote the significance of the between-group differences derived from a mixed model. Significance of the between-group differences at individual visits: *P⩽0.05; †P⩽0.01; ‡P⩽0.001.
Figure 2
Figure 2
Kaplan–Meier survival function estimates for the probability of reaching blood pressure control in patients randomised to old drugs (n=89) or new drugs (n=94). Control was a blood pressure lower than 140 mm Hg systolic and lower than 90 mm Hg diastolic. Vertical bars denote the s.e.

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