Published Online
on April 26, 2004

A more recent version of this article appeared on June 1, 2004

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Submitted on October 8, 2003
Revised on November 25, 2003

Determinants of Blood Pressure Response to Quinapril in Black and White Hypertensive Patients. The Quinapril Titration Interval Management Evaluation Trial

Evan Mokwe; Suzanne E. Ohmit; Samar A. Nasser; Tariq Shafi; Elijah Saunders; Errol Crook; Amanda Dudley; and John M. Flack^*

From the Department of Internal Medicine (E.M.), Department of Internal Medicine, Division of Endocrinology, Metabolism, and Hypertension (S.E.O., S.A.N., J.M.F.), Department of Internal Medicine, Academic Hospitalist Program (T.S.), Department of Internal Medicine, Division of Nephrology (E.C.), and Department of Internal Medicine, Cardiovascular Epidemiology and Clinical Applications (A.D.), Wayne State University, Detroit, Mich; Department of Medicine (E.S.), University of Maryland School of Medicine, Baltimore, Md.

^* To whom correspondence should be addressed. E-mail: jflack{at}intmed.wayne.edu.

Abstract--Race has been considered an important factor in determining blood pressure response to treatment and selection of antihypertensive drug therapy. Data collected during a clinical trial that evaluated rapidity of medication up-titration with blood pressure response to monotherapy with the angiotensin-converting enzyme (ACE) inhibitor quinapril were used to characterize response in 533 black and 2046 white participants. Our objectives were to examine the influence of race and other factors on blood pressure response and to assess the degree to which nonrace factors account for apparent racial differences in response. Average systolic and diastolic blood pressure responses (baseline minus follow-up) to treatment were assessed with treatment groups combined. Crude systolic and diastolic blood pressure responses averaged 4.7 and 2.4 mm Hg less, respectively, in black compared with white participants; however, the response distributions largely overlapped. In multivariate linear regression models adjusted for study design variables and measured participant characteristics, the racial difference in systolic response was reduced by 51% to 2.3 mm Hg, and diastolic response by 21% to 1.9 mm Hg. In these models, participant characteristics, including age, gender, body size, and pretreatment blood pressure severity, significantly predicted either attenuated or enhanced blood pressure response to treatment. Our findings demonstrate that a large source of variability of blood pressure response to treatment is within, not between, racial groups, and that factors that vary at the level of the individual contribute to apparent racial differences in response to treatment.

Key words: ACE inhibitors • antihypertensive therapy • blood pressure response • hypertension • race

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