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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Comparison of dual therapies for lowering blood pressure in black Africans
New England Journal of Medicine, Volume 380, No. 25, Year 2019
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Description
BACKGROUND The prevalence of hypertension among black African patients is high, and these patients usually need two or more medications for blood-pressure control. However, the most effective two-drug combination that is currently available for blood-pressure control in these patients has not been established. METHODS In this randomized, single-blind, three-group trial conducted in six countries in sub-Saharan Africa, we randomly assigned 728 black patients with uncontrolled hypertension (≥140/90 mm Hg while the patient was not being treated or was taking only one antihypertensive drug) to receive a daily regimen of 5 mg of amlodipine plus 12.5 mg of hydrochlorothiazide, 5 mg of amlodipine plus 4 mg of perindopril, or 4 mg of perindopril plus 12.5 mg of hydrochlorothiazide for 2 months. Doses were then doubled (10 and 25 mg, 10 and 8 mg, and 8 and 25 mg, respectively) for an additional 4 months. The primary end point was the change in the 24-hour ambulatory systolic blood pressure between baseline and 6 months. RESULTS The mean age of the patients was 51 years, and 63% were women. Among the 621 patients who underwent 24-hour blood-pressure monitoring at baseline and at 6 months, those receiving amlodipine plus hydrochlorothiazide and those receiving amlodipine plus perindopril had a lower 24-hour ambulatory systolic blood pressure than those receiving perindopril plus hydrochlorothiazide (between-group difference in the change from baseline, −3.14 mm Hg; 95% confidence interval [CI], −5.90 to −0.38; P=0.03; and −3.00 mm Hg; 95% CI, −5.8 to −0.20; P=0.04, respectively). The difference between the group receiving amlodipine plus hydrochlorothiazide and the group receiving amlodipine plus perindopril was −0.14 mm Hg (95% CI, −2.90 to 2.61; P=0.92). Similar differential effects on office and ambulatory diastolic blood pressures, along with blood-pressure control and response rates, were apparent among the three groups. CONCLUSIONS These findings suggest that in black patients in sub-Saharan Africa, amlodipine plus either hydrochlorothiazide or perindopril was more effective than perindopril plus hydrochlorothiazide at lowering blood pressure at 6 months. Copyright © 2019 Massachusetts Medical Society.
Authors & Co-Authors
Ojji, Dike Brevis
Nigeria, Abuja
University of Abuja
Mayosi, Bongani M.
Unknown Affiliation
Francis, Veronica M.
South Africa, Cape Town
Clinical Research Center
Badri, Motasim A.
Saudi Arabia, Riyadh
King Saud Bin Abdulaziz University for Health Sciences
Cornelius, Victoria R.
United Kingdom, London
Imperial College London
Smythe, Wynand A.
South Africa, Cape Town
Clinical Research Center
Kramer, Nicky
South Africa, Cape Town
Clinical Research Center
Barasa, Felix Ayub
Kenya, Eldoret
Moi Teaching and Referral Hospital
Damasceno, A. Antonio Moura
Mozambique, Maputo
Universidade Eduardo Mondlane
Dzudie, Anastase Innocent
Mozambique, Maputo
Universidade Eduardo Mondlane
Cameroon, Douala
Douala General Hospital
Jones, Erika S.W.
South Africa, Cape Town
Division of Nephrology and Hypertension
Mondo, Charles Kiiza
Uganda, Kampala
St. Francis Hospital Uganda
Ogah, Okechukwu Samuel
Nigeria, Ibadan
University College Hospital, Ibadan
Ogola, Elijah N.
Kenya, Nairobi
University of Nairobi
Sani, Mahmoud Umar
Nigeria, Kano
Aminu Kano Teaching Hospital
Shedul, Gabriel Lamkur
Nigeria, Abuja
University of Abuja
Shedul, Grace
Nigeria, Abuja
University of Abuja
Rayner, Brian L.
South Africa, Cape Town
Division of Nephrology and Hypertension
Okpechi, Ikechi Gareth
South Africa, Cape Town
Division of Nephrology and Hypertension
Sliwa, Karen S.
South Africa, Cape Town
University of Cape Town
Poulter, Neil R.
United Kingdom, London
Imperial College London
Statistics
Citations: 80
Authors: 21
Affiliations: 13
Identifiers
Doi:
10.1056/NEJMoa1901113
ISSN:
00284793
Research Areas
Disability
Health System And Policy
Noncommunicable Diseases
Study Design
Cross Sectional Study
Participants Gender
Female