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No evidence was found to support different advice based on age and ethnicity

According to a study published by the BMJ, the current UK guidelines on drug treatment for high blood pressure, which vary according to a patient’s age and ethnicity, could be simplified in line with other international guidelines.

The results show similar blood pressure reductions for three main drug types in people of all ages and races, suggesting that other factors may be better used to guide drug choice.

High blood pressure, or high blood pressure, affects more than one in four adults worldwide and is a major risk factor for illness and death.

With the exception of people with diabetes, the current guidelines of the National Institute for Excellence in Health and Care (NICE) recommend calcium channel blockers (CCBs) for people aged 55 and over and for people with a Black African or African-Caribbean family and angiotensin-converting enzyme inhibitors ( ACEIs) or angiotensin receptor blockers (ARBs) for non-black people under the age of 55.

This advice is based on the view that blacks and the elderly have different causes for high blood pressure and lower levels of renin (a protein that regulates blood pressure and fluid balance), which makes drugs that work in this particular way better at lowering of blood pressure in these populations.

However, since the development of the current guidelines in the early 2000s, new evidence has emerged that has questioned some whether recommendations based on age and ethnicity actually result in greater blood pressure reductions in current routine care.

To find out, researchers from the London School of Hygiene & Tropical Medicine used over 150,000 new users of hypertension drugs (CCBs, ACEIs / ARBs, and thiazides) without diabetes from 2007 to 2017.

Taking into account factors that might influence treatment choice or response, such as age, gender, smoking, alcohol consumption, weight (BMI), and underlying medical conditions, the researchers found similar blood pressure reductions associated with both CCBs and ACEIs / ARBs are available to people over and under 55 years of age.

In further analyzes, they found that CCBs were associated with a greater decrease in blood pressure than ACEIs / ARBs, but only in people aged 75 and over.

This was a large study using high quality data on primary care in the UK. However, the authors point out some limitations, such as: For example, the fact that patient compliance with medication and the small number of blacks included in the study cannot be analyzed.

Still, the researchers conclude that starting ACEIs / ARBs and CCBs was associated with similar blood pressure drops in people over and under 55 years of age, suggesting that age may not be the best factor in drug choice.

“Our results suggest that the UK’s current algorithmic approach to initial treatment for high blood pressure may not result in greater blood pressure reductions and could be simplified,” they write.

“Choosing one of the top three hypertension drug classes with proposed compelling indications for use would align the UK with international guidelines, particularly on age.”

ACEIs / ARBs not related to the severity or mortality of COVID-19

More information:
First-line therapy for hypertension and hypotension by age and ethnicity: Cohort study in UK primary care, BMJ (2020). DOI: 10.1136 / bmj.m4080 Provided by the British Medical Journal

Quote: The study asks questions about blood pressure medication based on age and ethnicity (2020, November 18) posted on November 18, 2020 from based.html

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