High blood pressure medication strategy proves effective in Hispanic women
Hispanic women with hypertension and coronary artery disease respond better to drug regimens aimed at controlling high blood pressure than non-Hispanic white women, University of Florida researchers report.
A UF study described in the current issue of the Journal of Women's Health revealed that when treated with either of two commonly prescribed medication strategies, Hispanic women achieved greater blood pressure control and were half as likely as white women to suffer adverse outcomes such as heart attack, stroke or death from any cause. The findings provide new data on a population of ethnic women who have been all but absent from such research.
"The study is unique in that we enrolled a substantial number of women and a substantial number of Hispanic patients from a variety of different Hispanic regions. As a result, we have data that enabled us to really fully evaluate the treatment of hypertension in this ethnically diverse group," said Rhonda Cooper-DeHoff, Pharm.D, M.S., a research assistant professor of medicine and associate director of the clinical research program in cardiovascular medicine at UF's College of Medicine.
UF researchers studied 22,500 patients enrolled in the landmark International Verapamil SR-Trandolapril study, known as INVEST, and tracked a subgroup of 5,017 Hispanic and 4,710 non-Hispanic white women who were randomly assigned to a drug strategy containing either a sustained release form of the calcium antagonist verapamil or the beta-blocker atenolol.
The INVEST study enrolled more Hispanic patients than any other hypertension trial to date, Cooper-DeHoff said, and included Hispanic participants from the mainland United States, Puerto Rico, Cuba, Mexico, Canada, Guatemala, Panama and El Salvador.
After 24 months of follow-up, researchers found that both treatment strategies worked - and worked better in the Hispanic women.
Blood pressure control, defined at less than 140/90 mmHg, was achieved in 75 percent of Hispanic women and 68 percent of non-Hispanic white women.
And despite having a higher prevalence of diabetes at baseline, only 5.7 percent of Hispanic women suffered from adverse cardiovascular outcomes, compared with 12.3 percent of non-Hispanic white women.
Cooper-DeHoff attributed the low incidence of adverse outcomes to the fact that Hispanic women enrolled in the study were younger. If follow-up had continued over a longer period of time, adverse outcomes in the Hispanic women may have increased, she said.
However, these women remained at a lower risk for these outcomes even after statisticians adjusted for age and other factors. Still, she warned that problems associated with diabetes are likely to show up in these patients down the road.
"Diabetes in and of itself imparts significant future adverse cardiovascular outcomes," she said. "These women should be well-monitored under the care of a physician so that they can prevent future cardiovascular morbidity and mortality related to hypertension and diabetes. Importantly, because the Hispanic population is the fastest-growing ethnic minority in the United States, Hispanics - especially women - should be included in future cardiovascular research in order to further our understanding of these high-risk diseases in Hispanic patients."
High blood pressure is becoming more prevalent in women across all ethnic groups, Cooper-DeHoff said. And although it is thought to actually be less common in Hispanic women, fewer Hispanics have been included in hypertension studies.
"The INVEST findings are important because they demonstrate that this treatment for Hispanic women really pays off," said Thomas G. Pickering, M.D., D. Phil., director of the Center for Behavioral Cardiovascular Health at Columbia University Medical Center. "They've got something really interesting with this study, and it wasn't something that could have been expected."