Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitor-Based Treatment on Cardiovascular Outcomes in Hypertensive Blacks Versus Whites

This retrospective study found that ACE-inhibitor-based antihypertensive therapy was associated with poorer cardiovascular outcomes compared with non-ACE inhibitor therapy in blacks but not in whites. These findings confirm previous clinical trial evidence.

The NICE clinical guideline on hypertension recommends step 1 antihypertensive treatment with a calcium-channel blocker (CCB) for black people of African or Caribbean family origin of any age. If a CCB is not suitable, for example because of oedema or intolerance, or if there is evidence of heart failure or a high risk of heart failure, then a thiazide-like diuretic should be offered. If blood pressure is not controlled by step 1 treatment, then step 2 treatment with a CCB in combination with an angiotensin receptor blocker should be offered (the latter should be considered in preference to an ACEI for black people of African or Caribbean family origin).