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ETHNIC DIFFERENCES IN RESPONSE TO COMBINATION ALISKIREN/HYDROCHLOROTHIAZIDE VERSUS RAMIPRIL MONOTHERAPY IN OBESE PATIENTS WITH STAGE 2 HYPERTENSION: PP.5.165

Objective: Activation of the renin-angiotensin-aldosterone system is an important mechanism in the pathogenesis of hypertension (HTN) associated with obesity. Several studies have reported ethnic differences in blood pressure (BP) response to commonly used antihypertensive drugs. Previously, an 8-week, prospective, multicenter, randomized, double-blind study (N=380) showed that a single-pill combination of aliskiren (A) with hydrochlorothiazide (HCTZ) reduced BP significantly more than ramipril (R) in obese patients (body mass index [BMI] >=30 kg/m2 but <=45 kg/m2; average BMI was 35.3 ± 4.4 kg/m2) with stage 2 HTN (mean sitting systolic BP [msSBP] >=160 and <200 mmHg). Here we present the effects of race/ethnicity on BP efficacy. Design and Methods: Change from baseline in msSBP and mean sitting diastolic BP (msDBP) and percentage of patients achieving BP control (<140/90 mmHg) are reported. Results: In all three racial/ethnic groups (Caucasian, African American, and Hispanic), A+HCTZ provided significant (P < 0.0001) reductions from baseline in both msSBP and msDBP. R reduced msSBP significantly in all three racial/ethnic groups, yet significant reductions in msDBP were observed only in Caucasians and Hispanics. Between-treatment differences were significant in favor of A+HCTZ for all measures in the Caucasian and African American groups (Table). In Hispanics, only the change in msDBP between-treatment groups was significant. The percentage of patients achieving BP control was significantly greater in the A+HCTZ group vs R group for both Caucasians and African Americans but not for Hispanics. In the overall study, adverse event rates were similar in both groups (35.8%, A+HCTZ; 37.3%, R); the most common being headache, nasopharyngitis, dizziness, and fatigue. Conclusion: The results show that across various ethnic and racial groups, A+HCTZ produces greater BP efficacy than R, although the differences between treatments were significant only for Caucasians and African Americans. Figure 1. No caption available.