Ethnicity and Second-Line Antihypertensive Medication Response in the ASCOT Trial

Hypertension, defined as systolic blood pressure (SBP) greater than 140 mm Hg or diastolic blood pressure (DBP) greater than 90 mm Hg, remains a significant problem that results in increased risk of cardiovascular disease [1]. Despite heightened recognition of this problem, less than 40% of patients are at their goal blood pressure (BP) [2]. There are multiple pharmacologic treatments for hypertension, and it has been known for some time that a patient’s likelihood to respond to a particular treatment may depend on that patient’s ethnic background [3]. This information has been used to guide initial monotherapy in different racial groups in order to provide optimal treatment, but there is little information regarding combination therapies across different ethnicities. Many patients require multiple drugs to achieve BP less than 140/90, and some guidelines suggest beginning treatment with a combination of two drugs if the initial BP is more than 20/10 points above goal [4]. The ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) study evaluated BP reduction in response to monotherapy as well as specific combinations of BP drugs in three different ethnic groups (European origin, African origin, and those from the Indian subcontinent) to evaluate whether a patient’s ethnicity plays a role in the outcomes of initial or combination BP therapy.