Blood Pressure Drugs Differ for Blacks, Whites

Several types of drugs can lower blood pressure, but some may be better than others for certain people.

Several types of drugs can lower blood pressure, but some may be better than others for certain people. Despite producing similar reductions in blood pressure, the beta-blocker drug atenolol (brandname, Tenormin) has advantages over the angiotensin-blocker losartan (Cozaar) for black patients with hypertension and enlargement of the left side of the heart, according to a report in the Journal of the American College of Cardiology. The finding comes from a trial called the LIFE study that was conducted in several countries, which showed overall that losartan provided better cardiovascular protection than atenolol in a broad population of hypertensive patients. However, based on an apparent effect of ethnic background in the LIFE study, Dr. Stevo Julius from University of Michigan, Ann Arbor, and colleagues, conducted a new analysis comparing cardiovascular events in black and non-black patients. They found that white patients had a lower risk of cardiovascular mortality, stroke, or heart attack with losartan, whereas black patients appeared to have a lower risk with atenolol. The researchers then focused on data from the U.S. arm of the study, where most of the black patients were enrolled. During the first two years of treatment, outcomes were similar for losartan and atenolol. After four years, however, the cardiovascular event rate for black patients was 15.3 percent in the losartan group, but only 9.7 percent in the atenolol group. As in the overall LIFE study, blood pressure reductions in black patients were similar with losartan and with atenolol. “We believe that our finding is sufficiently convincing to generate the hypothesis that black patients with hypertension and (left heart enlargement) might not respond as favorably to losartan-based treatment as non-black patients, with respect to cardiovascular outcomes,” the authors conclude, “and that these data do not support a recommendation for losartan as a first-line treatment for this purpose.” (Source: Journal of the American College of Cardiology: Reuters Health: MedLine Plus: April 2004.)