A LARGE meta-regression of randomised controlled trials (RCT) has shown that cardiovascular outcomes differ significantly across ethnic groups in patients receiving antihypertensive treatment, emphasising the need for more tailored approaches to therapy.
Hypertension is a leading driver of cardiovascular morbidity and mortality worldwide, but whether ethnicity influences treatment outcomes has remained debated. To address this, investigators conducted a systematic review and meta-regression analysis of RCTs published between 1997 and 2024, selecting studies that included homogeneous populations of Afro-American, Caucasian, or Asian patients with hypertension. Data were drawn from 24 RCTs encompassing 142,871 patients: 82,472 Caucasian, 16,221 Afro-American, and 44,178 Asian participants. Analyses adjusted for baseline systolic blood pressure, age, sex, a 10 mmHg reduction in systolic pressure, and high cardiovascular risk.
Clear differences emerged across ethnicities. Compared with Caucasian patients, Afro-American participants had significantly higher rates of major cardiovascular events, including myocardial infarction (9.8 events per 1000 patient-years; odds ratio [OR]: 1.003, 95% CI: 1.001–1.005; p=0.011), heart failure (9.6 per 1000; OR: 1.006, 95% CI: 1.003–1.008; p<0.001), stroke (10.5 per 1000; OR: 1.004, 95% CI: 1.000–1.007; p=0.037), and cardiovascular death (9.8 per 1000; OR: 1.006, 95% CI: 1.003–1.010; p=0.001). Asian patients, on the other hand, were more prone to stroke (11.9 events per 1000 patient-years; OR: 1.004, 95% CI: 1.002–1.007; p=0.002) but had a significantly lower risk of myocardial infarction (4.4 per 1000; OR: 0.998, 95% CI: 0.996–0.999; p=0.002).
The study highlights important ethnic disparities in cardiovascular morbidity and mortality among hypertensive patients. These findings suggest that ethnicity-specific risk patterns should be considered in the selection and optimisation of antihypertensive treatment strategies.
Reference
Bernardi M et al. Impact of ethnicity in outcomes of major cardiovascular events in adult patients with hypertension: a meta-regression analysis of 24 randomized trials. ESC Congress 2025, 29 August-1 September, 2025.
