A comparison of the efficacy and safety of a beta-blocker, a calcium channel blocker, and a converting enzyme inhibitor in hypertensive blacks

The medical care of black patients with hypertension (high blood pressure) presents some challenges to physicians. Hypertension is more prevalent among blacks than nonblacks and there is a higher proportion of blacks with uncontrolled hypertension. At an earlier age, black patients may have more severe coronary artery disease, congestive heart failure, stroke, peripheral vascular disease, and end-stage renal (kidney) disease. Black hypertensives are frequently younger than their nonblack counterparts, and they are less likely to be compliant with medication schedules. Recent studies have demonstrated that calcium channel blockers are equally effective in controlling blood pressure in black and nonblack patients. It has also been demonstrated that blacks do not respond as well to converting enzyme inhibitors or beta-blockers as do nonblack patients. Three hundred ninety-four black patients with hypertension were studied to compare the effects of the three major classes of hypotensive agents: beta-blockers, calcium channel blockers, and converting enzyme inhibitors. In addition, the efficacy, safety, and quality of life associated with atenolol, captopril, and verapamil sustained release (SR) given for mild to moderate hypertension were evaluated in black patients. The study was broken down into four periods: a two- to four-week lead-in with placebo; four weeks of initial therapy; four weeks of forced titration and maintenance; and one week of final therapy. There was a greater drop in diastolic and systolic blood pressures with verapamil SR than with the other treatments. All three agents were efficacious in controlling blood pressure in the black patients studied, but the calcium channel blocker was more effective in all three active-treatment study periods. Verapamil SR also produced a trend toward a dose-response for reducing systolic blood pressure that was not seen with the other two drugs, although the effect was not statistically significant. Most black patients exhibit a lower renin profile and previous studies have suggested that these patients do not respond as well to beta-blockers or converting enzyme inhibitors. Hypertensive blacks have problems with elevated peripheral resistance and they appear to be well suited to treatment with calcium antagonists from a pathophysiologic standpoint. It is important to remember that drugs that are effective in some patients are not necessarily effective in other groups. Greater effort needs to be made to individualize treatment rather than follow the traditional stepped approach to the management of hypertension. (Consumer Summary produced by Reliance Medical Information, Inc.)