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News

CWRU study offers insight to control hypertension

Case Western Reserve University : 11 February, 2007  (Technical Article)
Case Western Reserve University researchers have been able to set and achieve lower blood pressure goals in a study group of African Americans whose hypertension is difficult to control, according to a study published in The Archives of Internal Medicine, one of the JAMA/Archives journals.
According to the article, hypertension affects 28 percent of the U.S. population and 35 percent of the African-American population.

The authors write, '[African American] hypertensive patients [have been] historically perceived to have more severe blood pressure elevation and to be more resistant to therapy (especially monotherapy with two of the classes used in this trial, beta-blocker and ACE inhibitor). Furthermore, because of the study population's lower education level, fewer financial resources and less positive interaction with the health care system, long-term maintenance of blood pressure control was also expected to be a challenge.'

Jackson T. Wright Jr. of CWRU and colleagues studied whether lower blood pressure goals could be achieved by African-American patients who were being treated for hypertension as part of the African-American Study of Kidney Disease and Hypertension. One thousand ninety four (1,094) African-American participants in the AASK study aged 18 to 70 years old were assigned to two target blood pressure groups. The normal mean arterial pressure group was to reach MAP levels of 102 to 107 mm/Hg, approximately a blood pressure of 140/90 mm/hg. The low MAP group was assigned to reach MAP levels of 93 mm/Hg or lower, approximately a blood pressure of 125/75 mm/Hg or lower.

Participants were also randomly assigned to receive ramipril (an ACE inhibitor), amlodipine (a calcium channel blocker) or metoprolol succinate (a beta-blocker). Additional medications were added as needed at the discretion of participants' physicians.

Participants were followed for a total 14 months. Participants had their blood pressures measured and medications modified if needed once a month for the first six months of the study and once a month for the duration of the study. If MAP levels were 5 mm/Hg over the goal MAP level for two consecutive visits, patients were seen again within two weeks, and their treatments were evaluated and changes were made to their medications as suggested by their physicians.

The researchers found that in the group assigned to achieve usual MAP levels, the percentage that achieved a MAP of 107 mm/Hg increased from 30.8 percent at the start of the study to 87.7 percent at 14 months into the trial and the percentage of this group that achieved blood pressures of less than 140/90 mm/Hg increased from 20 percent at the start of the study to 78.9 percent at 14 months. Among participants assigned to the low MAP group, the percentage who achieved a MAP level of 92 mm/Hg or less increased from 31.7 percent of participants at the beginning of the study to 73.1 percent at 14 months, and the percentage with blood pressures of 125/75 mm/Hg increased from 21.5 percent at the beginning of the study to 41.8 percent at 14 months.

The researchers write, 'Participants at or below MAP goal received an average of 2.7 and 3.5 agents [medications] in the normal MAP goal and low MAP goal groups, respectively. The AASK participants above MAP goal are prescribed, on average, a greater number of agents than those participants at or below goal, suggesting that resistance to treatment or non-adherence rather than underprescribing of antihypertensive drugs was the reason for the inability to reach MAP goal.'

'The blood pressure goals set and achieved in AASK participants clearly demonstrate that adequate blood pressure control can be achieved even in the most difficult-to-control hypertensive populations,' the authors conclude.

This study was funded under a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases, (Bethesda, Md), and by grants from other institutions.
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