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

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 <.0001), death (HR, 1.35; 95% CI, 1.03-1.76; P =.03), myocardial infarction (HR, 4.00; 95% CI, 1.34-11.96; P =.01), stroke (HR, 1.97; 95% CI, 1.34-2.92; P =.001), and heart failure (HR, 3.00; 95% CI, 1.99-4.54; P <.0001). For the angiotensin-converting enzyme inhibitors vs β-blocker comparison, the outcomes between the groups were not significantly different. Conclusions In a real-world cohort of hypertensive blacks, angiotensin-converting enzyme inhibitors were associated with a higher risk of cardiovascular events when compared with calcium channel blockers or thiazide diuretics.