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

William Cushman, Domenic J. Reda, H. Mitchell Perry, David Williams, Mazen Abdellatif, Barry J. Materson

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Abstract

Background: Stroke incidence and mortality rates are higher in the southeastern region of the United States, which is called the 'Stroke Belt.' We compared the response to antihypertensive medication use in patients from different US regions. Methods: The short-term and 1-year efficacy of the antihypertensive medications hydrochlorothiazide, atenolol, diltiazem hydrochloride (sustained release), captopril, prazosin hydrochloride, and clonidine was compared by US region in a randomized controlled trial of 1105 men with hypertension from 15 US Veterans Affairs medical centers. Results: Compared with patients outside the Stroke Belt, patients inside the Stroke Belt achieved significantly lower treatment success rates of diastolic 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 inside the Stroke Belt had significantly lower treatment success rates with hydrochlorothiazide (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 atenolol (P = .02) or prazosin (P = .03) and more likely with diltiazem (P = .05). 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 with captopril (P = .07). Many regional and racial differences in diet, lifestyle, and other characteristics were observed. After adjustment for these characteristics by regression analysis, the effect of residing inside the Stroke Belt remained for captopril (P = .01) and clonidine (P = .01) and approached significance for hydrochlorothiazide (P = .10). Conclusions: Hypertension in patients residing inside the Stroke Belt responded less to the use of several antihypertensive medications and important differences were shown in a number of characteristics that may affect the control of blood pressure, compared with patients residing outside the Stroke Belt.

Original languageEnglish (US)
Pages (from-to)825-831
Number of pages7
JournalArchives of Internal Medicine
Volume160
Issue number6
DOIs
StatePublished - Mar 27 2002

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Antihypertensive Agents
Randomized Controlled Trials
Stroke
Hypertension
Hydrochlorothiazide
Atenolol
Captopril
Clonidine
Diltiazem
Prazosin
Blood Pressure
Southeastern United States
Therapeutics
United States Department of Veterans Affairs
Life Style
Regression Analysis
Diet
Mortality
Incidence

All Science Journal Classification (ASJC) codes

  • Internal Medicine

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Regional and racial differences in response to antihypertensive medication use in a randomized controlled trial of men with hypertension in the United States. / Cushman, William; Reda, Domenic J.; Perry, H. Mitchell; Williams, David; Abdellatif, Mazen; Materson, Barry J.

In: Archives of Internal Medicine, Vol. 160, No. 6, 27.03.2002, p. 825-831.

Research output: Contribution to journalArticle

Cushman, William ; Reda, Domenic J. ; Perry, H. Mitchell ; Williams, David ; Abdellatif, Mazen ; Materson, Barry J. / Regional and racial differences in response to antihypertensive medication use in a randomized controlled trial of men with hypertension in the United States. In: Archives of Internal Medicine. 2002 ; Vol. 160, No. 6. pp. 825-831.
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AU - Reda, Domenic J.

AU - Perry, H. Mitchell

AU - Williams, David

AU - Abdellatif, Mazen

AU - Materson, Barry J.

PY - 2002/3/27

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N2 - Background: Stroke incidence and mortality rates are higher in the southeastern region of the United States, which is called the 'Stroke Belt.' We compared the response to antihypertensive medication use in patients from different US regions. Methods: The short-term and 1-year efficacy of the antihypertensive medications hydrochlorothiazide, atenolol, diltiazem hydrochloride (sustained release), captopril, prazosin hydrochloride, and clonidine was compared by US region in a randomized controlled trial of 1105 men with hypertension from 15 US Veterans Affairs medical centers. Results: Compared with patients outside the Stroke Belt, patients inside the Stroke Belt achieved significantly lower treatment success rates of diastolic 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 inside the Stroke Belt had significantly lower treatment success rates with hydrochlorothiazide (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 atenolol (P = .02) or prazosin (P = .03) and more likely with diltiazem (P = .05). 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 with captopril (P = .07). Many regional and racial differences in diet, lifestyle, and other characteristics were observed. After adjustment for these characteristics by regression analysis, the effect of residing inside the Stroke Belt remained for captopril (P = .01) and clonidine (P = .01) and approached significance for hydrochlorothiazide (P = .10). Conclusions: Hypertension in patients residing inside the Stroke Belt responded less to the use of several antihypertensive medications and important differences were shown in a number of characteristics that may affect the control of blood pressure, compared with patients residing outside the Stroke Belt.

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