Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa

To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After >= 4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25mg (n = 89; R) or amlodipine/valsartan 5/160 mg (n = 94; E) and followed up for 6 months. To control blood pressure ( <140/ <90 mm Hg), bisoprolol and amlodipine could be doubled (10mg per day) and alpha-methyldopa (0.5-2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (-0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P <0.0001) systolic, 1.3 mm Hg (P = 0.12) diastolic, and 9.6 beats per minute (P <0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P <0.0001) systolic, 1.8 mm Hg (P = 0.07) diastolic and 9.8 beats per minute (P <0.0001). In R compared with E patients, 45 vs 37% (P = 0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P <0.0001) had alpha-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P = 0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients.