As a treatment for high blood pressure in black patients, no drug is really better than another at reducing the risk of death and pressure-related problems - provided that the patient’s goal blood pressure is reached. That’s where the drugs differ: it may be easier to reach this goal with certain drugs rather than with others.

As reported in the Annals of Internal Medicine, Dr. Lizzy M. Brewster, from the Academic Medical Center in Amsterdam, the Netherlands, and colleagues searched several databases to identify trials that evaluated the effectiveness of various types of blood pressure drugs in black patients. Thirty trials were found that included a total of 20,000 black patients.

Beta-blockers, which include drugs like Tenormin and Inderal, and ACE inhibitors, which include drugs like Accupril and Zestril, were no more effective than inactive placebo treatment in reducing the upper and lower numbers, respectively, reported on a blood pressure reading.

In contrast, all other classes of blood pressure drugs were more effective than placebo at reducing blood pressure, the researchers found. Still, the only drug class that was consistently better than placebo in all patients was calcium-channel blockers, which include drugs like Cardizem and Procardia.

As noted, so long as the goal blood pressure was achieved, the type of drug used did not influence outcomes such as stroke, kidney failure, and death due to cardiovascular disorders.

However, there was some evidence that the risk of diabetes may have increased with water pills (diuretics), and cardiovascular events with ACE inhibitors, compared with other blood pressure drugs.

“Drugs that ensure tight blood pressure control and have the lowest risk for side effects should be used in black patients” with high blood pressure, the researchers state. The present analysis suggests that calcium-channel blockers might be the best first-line agent, followed by diuretics for patients who cannot afford such drugs.

SOURCE: Annals of Intern Medicine, October 19, 2004.