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

JR M’Buyamba-Kabangu, BC Anisiuba, MB Ndiaye, D Lemogoum, L Jacobs, CK Ijoma, L Thijs, HJ Boombhi, J Kaptue, PM Kolo, JB Mipinda, CE Osakwe, A Odili, B Ezeala-Adikaibe, S Kingue, BA Omotoso, SA Ba, II Ulasi and JA Staessen on behalf of the Newer versus Older Antihypertensive Agents in African Hypertensive Patients Trial (NOAAH) Investigators


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 5/6.25 mg (n = 89; R) or mlodipine/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 (10 mg per day) and a-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 a-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.

Link to full text