Comparative Effectiveness of Calcium-Channel Blockers, Angiotensin-Converting Enzyme/Angiotensin Receptor Blockers and Diuretics on Cardiovascular Events Likelihood in Hypertensive African-American and Non-Hispanic Caucasians: A Retrospective Study Across HCA Healthcare

Abstract

Background

Hypertension, a leading global risk factor for mortality and disability, disproportionately affects racial and ethnic minorities. Our study investigates the association between the type of prior antihypertensive medication use and the likelihood of cardiovascular events (CVE) and assesses whether the patient's race influences this relationship.

Methods

A retrospective study of 14 836 hypertension cases aged ≥ 40 years was conducted using data from HCA Healthcare between 2017 and 2023. Logistic regression was employed to predict the likelihood of CVE and mortality at admission, adjusting for baseline comorbidities, with Race added as an effect modifier. Interaction analysis was performed among races based on antihypertensive medication types.

Results

African American patients on ACE inhibitors (ACE) or angiotensin receptor blockers (ARBs) were 1.7 times more likely to have cardiovascular events (CVE) compared to those on calcium channel blockers (CCBs) and 0.66 times as likely compared to diuretics. CCB users had a lower CVE risk than diuretic users. Among White patients, ACE/ARB users had a 1.18 times higher CVE risk than CCB users and 0.45 times lower compared to diuretics, while CCBs offered a 0.38 times lower risk than diuretics. Only ACE/ARB use showed significantly higher CVE odds for African Americans compared to White patients, with similar risks across racial groups for CCBs and diuretics.

Conclusion

Prior antihypertensive type significantly influenced CVE risk, with race as an effect modifier. CCB users had lower CVE odds than ACE/ARBs or diuretics, and ACE/ARBs showed reduced CVE likelihood compared to diuretics in both racial groups.