Faculty Bibliography

Hydrochlorthiazide (HCTZ) is one of the most commonly prescribed antihypertensive drugs worldwide. More than 97% of all HCTZ prescriptions are for 12.5 to 25 mg per day. The purpose of this study was to evaluate the antihypertensive efficacy ofHCTZby clinic blood pressure (BP) and ambulatory BP (ABP) monitoring when compared to other anti-hypertensives. A systematic review was performed using Medline, Cochrane, Scopus and Embase databases for all randomized trials that assessed both clinic and 24-h ABP with HCTZ in comparison with other antihypertensive drugs. In addition, trials were selected only if they studiedHCTZas monotherapy and have trial duration of at least 4 weeks. Eleven studies (16 comparisons) with 918 patients fulfilled the inclusion criteria. All the studies used HCTZ dose 12.5 to 25 mg/day except one study that used a dose of 25-50 mg/day. The decrease in clinic BP with HCTZ was systolic 12.1mmHg (95% confidence interval [CI]: 6.0 to 18.3mmHg) and diastolic 6.3mmHg (95% CI: 2.8 to 9.9 mm Hg). The reduction in 24-h ABP with HCTZ was systolic 6.4 mm Hg (95% CI: 5.0 to 7.7 mm Hg) and diastolic 3.3 mm Hg (95% CI: 1.8 to 4.9 mm Hg). In head-to-head comparisons with other antihypertensive drug classes, compared to HCTZ, ACE inhibitors/ARBs resulted in significant greater reduction in systolic clinic andABPby 4.5/2.3mmHg, beta-blockers by 8.1/6.2 mm Hg, calcium antagonists by 3.2/2.5 mm Hg and thiazide-type diuretics by 7.8/5.3 mm Hg. Similarly, other anti-hypertensive drug classes resulted in significantly greater reduction of diastolic ABP and clinic

Background: In the United States, 40% of African Americans are disproportionately affected by hypertension leading to severe comorbidity and eventual mortality. Ethnic differences in hypertension among the various African American groups are not well documented. We evaluated the blood pressure control rates of Caribbean and West African born African Americans compared to US born African Americans attending New York City Health and Hospitals Corporation (NYC HHC) facilities. Methods: Data from NYC HHC clinical data warehouse were extracted for hypertensive patients seen between January 2004 and December 2009. Ethnic origin was based on self-reported country of birth (United States, the Caribbean, and West Africa). Blood pressure (BP) was scored by taking the average of 3 or more blood pressure measurements over the course of 3 months of HHC data. All BP measurements were made in the clinical setting and uncontrolled hypertension was defined as BP >140/90 mm Hg. All BPs were measured at least 4 months after hypertension diagnosis. We also extracted information regarding comorbid diagnoses, number of prescribed antihypertensive classes, number of medical visits, age, sex, BMI and mortality. We compared the groups using cox proportional hazard regression models. Results: The sample was composed of 25,142 African Americans of whom 13,778 (54.8%) were US born, 10,032 (39.9%) were Caribbean born, and 1,332 (5.3%) were West African born. The mean sample age was 51 (14.2) years, the mean BMI was 32.4 (11.0) and the sample was 61.4% (N=15,449) female. Compared to US born African Americans, Caribbean and West African born African Americans had higher levels of systolic blood pressure (3.8mmHg; p<.001 and 2.4mmHg; p<.001 respectively) and were more likely to have uncontrolled BP (OR=1.40;p<.001 and OR=1.21;p=.002, respectively). These differences were found in unadjusted models and after adjustment for age, sex, BMI, number of classes of antihypertensive medications prescribed, comorbidity, number of BP measurements, and length of HTN diagnosis. However, US born African Americans had higher rates of mortality (11.6%) compared to Caribbean born (6.0%) and West African born (2.5%) African Americans, which was confirmed by unadjusted and fully adjusted cox proportional hazards regression models. Conclusion: Ethnic differences in cardiovascular outcomes and mortality exist among hypertensive African Americans served by NYC HHC. US born African Americans have a lower survival rate despite lower BP and better BP control than Caribbean and West African born African Americans. Future studies on African Americans should take ethnic variations within these populations into account

BACKGROUND: The benefit of </=6-month compared with 12-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement remains controversial. We performed a meta-analysis and meta-regression of 40 was identified, effects were obtained with random models. RESULTS: Nine RCTs were included with total n = 19,224 patients. No significant differences were observed between