Racial differences in blood pressure response to angiotensin-converting enzyme inhibitors in children: a meta-analysis

Abstract

Angiotensin-converting enzyme (ACE) inhibitors are frequently used to treat hypertension in children.(1) ACE inhibitors alter the balance between the vasoconstrictive, salt-retentive, and cardiac hypertrophic properties of angiotensin II and the vasodilatory and natriuretic properties of bradykinin; they also alter the metabolism of other vasoactive substances.(2) Through these mechanisms, ACE inhibitors decrease systemic vascular resistance and promote natriuresis without increasing heart rate. This study evaluated the results of six trials of ACE inhibitors in children, using meta-analytic techniques to estimate the effect of race on blood pressure response.

Figure 1

Systolic blood pressure response to individual drugs and aggregate response (last line of data) compared with baseline (shown by the vertical line at 1) by % change at high-dose drug. Data are graphically shown as point estimates with 95 % confidence intervals. Estimates that fall between 0.5 and l denote a negative % change, and estimates that fall between 1 and 2 denote a positive % change. A—All races B—White race C—Black race

Figure 2

Diastolic blood pressure response to individual drugs and aggregate response (last line of data) compared with baseline (shown by the vertical line a 1) by % change at high-dose drug. Data are graphically shown as point estimates with 95 % confidence intervals. Estimates that fall between 0.5 and l denote a negative % change, and estimates that fall between 1 and 2 denote a positive % change. A—All races B—White race C—Black race