Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks

Sripal Bangalore, Gbenga Ogedegbe, Joyce Gyamfi, Yu Guo, Jason Roy, Keith Goldfeld, Christopher Torgersen, Louis Capponi, Christopher Phillips, Nirav R. Shah

Research output: Contribution to journalArticle

Abstract

Background Angiotensin-converting enzyme inhibitors are used widely in the treatment of patients with hypertension. However, their efficacy in hypertensive blacks when compared with other antihypertensive agents is not well established. Methods We performed a cohort study of patients using data from a clinical data warehouse of 434,646 patients from New York City's Health and Hospitals Corporation from January 2004 to December 2009. Patients were divided into the following comparison groups: angiotensin-converting enzyme inhibitors vs calcium channel blockers, angiotensin-converting enzyme inhibitors vs thiazide diuretics, and angiotensin-converting enzyme inhibitors vs β-blockers. The primary outcome was a composite of death, myocardial infarction, and stroke. Secondary outcomes included the individual components and heart failure. Results In the propensity score-matched angiotensin-converting enzyme inhibitors vs calcium channel blocker comparison cohort (4506 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.19-1.77; P =.0003), myocardial infarction (HR, 3.40; 95% CI, 1.25-9.22; P =.02), stroke (HR, 1.82; 95% CI, 1.29-2.57; P =.001), and heart failure (HR, 1.77; 95% CI, 1.30-2.42; P =.0003) when compared with calcium channel blockers. For the angiotensin-converting enzyme inhibitors vs thiazide diuretics comparison (5337 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (HR, 1.65; 95% CI, 1.33-2.05; P

Original languageEnglish (US)
Pages (from-to)1195-1203
Number of pages9
JournalAmerican Journal of Medicine
Volume128
Issue number11
DOIs
StatePublished - Nov 1 2015

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Angiotensin-Converting Enzyme Inhibitors
Antihypertensive Agents
Confidence Intervals
Calcium Channel Blockers
Sodium Chloride Symporter Inhibitors
Heart Failure
Stroke
Myocardial Infarction
Propensity Score
Urban Hospitals
Cohort Studies
Hypertension
Health

Keywords

  • Angiotensin-converting enzyme inhibitors
  • Blacks
  • Hypertension

ASJC Scopus subject areas

  • Medicine(all)

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Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks. / Bangalore, Sripal; Ogedegbe, Gbenga; Gyamfi, Joyce; Guo, Yu; Roy, Jason; Goldfeld, Keith; Torgersen, Christopher; Capponi, Louis; Phillips, Christopher; Shah, Nirav R.

In: American Journal of Medicine, Vol. 128, No. 11, 01.11.2015, p. 1195-1203.

Research output: Contribution to journalArticle

Bangalore, S, Ogedegbe, G, Gyamfi, J, Guo, Y, Roy, J, Goldfeld, K, Torgersen, C, Capponi, L, Phillips, C & Shah, NR 2015, 'Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks', American Journal of Medicine, vol. 128, no. 11, pp. 1195-1203. https://doi.org/10.1016/j.amjmed.2015.04.034
Bangalore, Sripal ; Ogedegbe, Gbenga ; Gyamfi, Joyce ; Guo, Yu ; Roy, Jason ; Goldfeld, Keith ; Torgersen, Christopher ; Capponi, Louis ; Phillips, Christopher ; Shah, Nirav R. / Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks. In: American Journal of Medicine. 2015 ; Vol. 128, No. 11. pp. 1195-1203.
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AU - Bangalore, Sripal

AU - Ogedegbe, Gbenga

AU - Gyamfi, Joyce

AU - Guo, Yu

AU - Roy, Jason

AU - Goldfeld, Keith

AU - Torgersen, Christopher

AU - Capponi, Louis

AU - Phillips, Christopher

AU - Shah, Nirav R.

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AB - Background Angiotensin-converting enzyme inhibitors are used widely in the treatment of patients with hypertension. However, their efficacy in hypertensive blacks when compared with other antihypertensive agents is not well established. Methods We performed a cohort study of patients using data from a clinical data warehouse of 434,646 patients from New York City's Health and Hospitals Corporation from January 2004 to December 2009. Patients were divided into the following comparison groups: angiotensin-converting enzyme inhibitors vs calcium channel blockers, angiotensin-converting enzyme inhibitors vs thiazide diuretics, and angiotensin-converting enzyme inhibitors vs β-blockers. The primary outcome was a composite of death, myocardial infarction, and stroke. Secondary outcomes included the individual components and heart failure. Results In the propensity score-matched angiotensin-converting enzyme inhibitors vs calcium channel blocker comparison cohort (4506 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.19-1.77; P =.0003), myocardial infarction (HR, 3.40; 95% CI, 1.25-9.22; P =.02), stroke (HR, 1.82; 95% CI, 1.29-2.57; P =.001), and heart failure (HR, 1.77; 95% CI, 1.30-2.42; P =.0003) when compared with calcium channel blockers. For the angiotensin-converting enzyme inhibitors vs thiazide diuretics comparison (5337 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (HR, 1.65; 95% CI, 1.33-2.05; P

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