Why do hypertensive patients of African ancestry respond better to calciumblockers and diuretics than to ACE inhibitors and β-adrenergic blockers? Asystematic review

Abstract

Clinicians are encouraged to take an individualized approach when treatinghypertension in patients of African ancestry, but little is known about whythe individual patient may respond well to calcium blockers and diuretics,but generally has an attenuated response to drugs inhibiting therenin-angiotensin system and to β-adrenergic blockers. Therefore, wesystematically reviewed the factors associated with the differential drugresponse of patients of African ancestry to antihypertensive drugtherapy. Using the methodology of the systematic reviews narrative synthesis approach,we sought for published or unpublished studies that could explain thedifferential clinical efficacy of antihypertensive drugs in patients ofAfrican ancestry. PUBMED, EMBASE, LILACS, African Index Medicus and the Foodand Drug Administration and European Medicines Agency databases weresearched without language restriction from their inception through June2012. We retrieved 3,763 papers, and included 72 reports that mainly considered the4 major classes of antihypertensive drugs, calcium blockers, diuretics,drugs that interfere with the renin-angiotensin system and β-adrenergicblockers. Pharmacokinetics, plasma renin and genetic polymorphisms did notwell predict the response of patients of African ancestry toantihypertensive drugs. An emerging view that low nitric oxide and highcreatine kinase may explain individual responses to antihypertensive drugsunites previous observations, but currently clinical data are verylimited. Available data are inconclusive regarding why patients of African ancestrydisplay the typical response to antihypertensive drugs. In lieu ofbiochemical or pharmacogenomic parameters, self-defined African ancestryseems the best available predictor of individual responses toantihypertensive drugs.