研究组招募最新使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI / ARB），钙离子通道阻滞剂（CCB）和噻嗪类的参与者。主要观察指标为从基线到第12、26和52周的随访，按年龄（<v≥55）和种族（黑人v非黑人）分层来比较ACEI / ARB与CCB新使用者的收缩压变化。次要分析包括CCB和噻嗪类新使用者的比较。
随访一年，研究组共纳入ACEI / ARB新使用者87440人，CCB新使用者67274人，噻嗪类药物新使用者22040人。对于没有糖尿病且年龄小于55岁的非黑人，在第12周时，使用CCB与使用ACEI / ARB相比，收缩压降低更大，降低幅度差异为1.69 mmHg；55周岁及以上的人群降低幅度差异仅为0.40 mmHg。
在更详细的年龄分层中，没有糖尿病的非黑人亚组分析中，仅75岁及以上的人群使用CCB与ACEI / ARB相比，可使收缩压下降更大。在没有糖尿病的黑人人群中，使用CCB的收缩压下降幅度比ACEI / ARB更大，差异为2.15 mmHg，而在没有糖尿病的非黑人人群中，相应差异仅为0.98 mmHg。
研究结果表明，年龄在55岁以下和55岁以上的非糖尿病非黑人中，使用CCB和使用ACEI / ARB疗效相差不大，血压的降低与新使用ACEI / ARB有关。对于没有糖尿病的黑人，与没有糖尿病的非黑人相比，使用CCB的血压降低幅度要比ACEI / ARB大得多。这表明当前用于一线抗高血压治疗的UK指南不一定能有效降压。
Title: First line drug treatment for hypertension and reductions in blood pressure according to age and ethnicity: cohort study in UK primary care
Author: Sarah-Jo Sinnott, Ian J Douglas, Liam Smeeth, Elizabeth Williamson, Laurie A Tomlinson
Objective To study whether treatment recommendations based on age and ethnicity according to United Kingdom (UK) clinical guidelines for hypertension translate to blood pressure reductions in current routine clinical care.
Design Observational cohort study.
Setting UK primary care, from 1 January 2007 to 31 December 2017.
Participants New users of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), calcium channel blockers (CCB), and thiazides.
Main outcome measures Change in systolic blood pressure in new users of ACEI/ARB versus CCB, stratified by age (< v ≥55) and ethnicity (black v non-black), from baseline to 12, 26, and 52 week follow-up. Secondary analyses included comparisons of new users of CCB with those of thiazides. A negative outcome (herpes zoster) was used to detect residual confounding and a series of positive outcomes (expected drug effects) was used to determine whether the study design could identify expected associations.
Results During one year of follow-up, 87440 new users of ACEI/ARB, 67274 new users of CCB, and 22040 new users of thiazides were included (median 4 (interquartile range 2-6) blood pressure measurements per user). For non-black people who did not have diabetes and who were younger than 55, CCB use was associated with a larger reduction in systolic blood pressure of 1.69 mm Hg (99% confidence interval 2.52 to 0.86) relative to ACEI/ARB use at 12 weeks, and a reduction of 0.40 mm Hg (0.98 to 0.18) in those aged 55 and older. In subgroup analyses using six finer age categories of non-black people who did not have diabetes, CCB use versus ACEI/ARB use was associated with a larger reduction in systolic blood pressure only in people aged 75 and older. Among people who did not have diabetes, systolic blood pressure decreased more with CCB use than with ACEI/ARB use in black people (reduction difference 2.15 mm Hg (6.17 to 1.87)); the corresponding reduction difference was 0.98 mm Hg (1.49 to 0.47) in non-black people.
Conclusions Similar reductions in blood pressure were found to be associated with new use of CCB as with new use of ACEI/ARB in non-black people who did not have diabetes, both in those who were aged younger than 55 and those aged 55 and older. For black people without diabetes, CCB new use was associated with numerically greater reductions in blood pressure than ACEI/ARB compared with non-black people without diabetes, but the confidence intervals were overlapping for the two groups. These results suggest that the current UK algorithmic approach to first line antihypertensive treatment might not lead to greater reductions in blood pressure. Specific indications could be considered in treatment recommendations.