Similar effect of losartan/hydrochlorothiazide therapy for black and non-black patients with severe hypertension

Previous research has demonstrated that black patients (B) are less responsive than non-black patients (NB) to a variety of antihypertensive agents. To further test this observation, we examined data from a recent study of losartan/HCTZ (L/H) versus losartan (L) as initial therapy in patients with severe hypertension (trough sitting diastolic blood pressure [DBP] ≥ 110 mmHg). In this post-hoc analysis, we assessed the difference in blood pressure (BP) response in B vs NB with severe hypertension. In this 6-week, double-blind study, patients were randomized (2:1) to L/H or L and titrated as needed at 2 week intervals. The primary endpoint was the proportion of patients who achieved goal (DBP < 90 mm Hg) at 4 weeks on L 50/H 12.5 mg vs L (L 50 mg titrated as needed to L 100 mg). Patients randomized to L/H therapy were titrated from L 50/H 12.5 mg to L 100/H 25 mg. Patients on L were titrated from L 50 mg to L 100 mg to L 150 mg. Patients on L 50/H 12.5 mg were sham titrated at the initial 2 week time point unless DBP was ≥110 mmHg. Patients on L/H who required titration at 2 weeks were considered not to have achieved goal BP at 4 weeks. P-values were based on a two-sided likelihood-ratio χ2 statistic. The percent of patients who achieved goal DBP at 4 and 6 weeks is shown below. There was no significant interaction between treatment and race. A similar observation was made for systolic BP. In this post-hoc analysis of patients with severe hypertension, more patients achieved goal BP on L/H than on L. There was no evidence of differential response in black patients compared to non-black patients. Initial combination therapy with L/H appears as effective in black patients as non-black patients with severe hypertension. (See Table)