A review of the efficacy and tolerability of combination amlodipine/valsartan in non-white patients with hypertension

Abstract

This article discusses racial/ethnic disparities in hypertension, with particular focus on non-white populations including blacks, Hispanics/Latinos, and Asians. Hypertension and its related morbidity and mortality affect a disproportionate number of black patients compared with white patients. Blacks, Hispanics/Latinos, and Asians have poor rates of hypertension awareness, treatment, and control. Given the high prevalence of comorbidities (e.g., obesity, diabetes, and metabolic syndrome) in these populations, renin-angiotensin-aldosterone system blockers are a good choice for foundation therapy. This review also discusses the importance of adherence and persistence with antihypertensive medication, which remain suboptimal in these non-white populations. Evidence suggests improvement with the use of single-pill combination therapy. Lastly, clinical trial data on the antihypertensive efficacy and safety of the combination of a dihydropyridine calcium channel blocker and an angiotensin receptor blocker, a widely utilized combination, in non-white populations are presented. PubMed was searched using the title/abstract key words (amlodipine AND valsartan AND [hypertension OR hypertensive] AND [black(s) OR African American(s) OR Hispanic(s) OR Latino(s) OR Mexican(s) OR Asian(s)]). In total, eight studies in patients with stage 1 or 2 hypertension were identified (n = 1,111 black, n = 389 Hispanic/Latino, and n = 3,094 Asian). Results showed that treatment with the combination of amlodipine plus valsartan is a reasonable choice for initial therapy or in patients who fail to respond to monotherapy. These drug classes have complementary mechanisms of action and, when used concomitantly, the magnitude of blood pressure lowering in these non-white populations is generally comparable with that seen in non-Hispanic white patients.

Fig. 1

Complementary mechanisms of action (MOA) of dihydropyridine calcium channel blockers (CCBs) and angiotensin receptor blockers (ARBs) in lowering blood pressure (BP). Reprinted from Neutel [47], with permission from JTE Multimedia

Fig. 2

Conditions favoring the use of dihydropyridine calcium channel blockers (CCBs) and angiotensin receptor blockers (ARBs) according to guidelines for the management of hypertension. Reprinted with permission of Dove Medical Press Ltd, from Waeber and Ruilope [48]; permission conveyed through Copyright Clearance Center, Inc