{"id":"c0a146c15170","type":"article","url":"https://hartvaat.nl/2019/06/20/vergelijking-van-duale-therapieen-voor-bloeddrukverlaging-bij-afrikaanse-afrikan/","title":"Vergelijking van duale therapieën voor bloeddrukverlaging bij Afrikaanse Afrikanen: NEJM","title_en":"Comparison of Dual Therapies for Lowering Blood Pressure in Black Africans.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","dubbele-trombocytenremming"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1901113","source_url":"https://doi.org/10.1056/NEJMoa1901113","authors":["Dike B Ojji","Bongani Mayosi","Veronica Francis","Motasim Badri","Victoria Cornelius","Wynand Smythe","Nicky Kramer","Felix Barasa","Albertino Damasceno","Anastase Dzudie","Erika Jones","Charles Mondo","Okechukwu Ogah","Elijah Ogola","Mahmoud U Sani","Gabriel L Shedul","Grace Shedul","Brian Rayner","Ikechi G Okpechi","Karen Sliwa","Neil Poulter"],"significance":8,"published":"2019-06-20","source_date":"2019-06-20","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This NEJM trial compared two dual antihypertensive combinations (amlodipine-hydrochlorothiazide versus perindopril-hydrochlorothiazide) in black African patients with hypertension, providing evidence to guide initial combination therapy in this underrepresented population with high hypertension prevalence.","created":"2026-07-03T10:28:00Z","updated":"2026-07-03T18:38:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM gerandomiseerde trial die twee duale antihypertensivacombinaties vergeleek bij zwarte Afrikanen met hypertensie. Evidencebase voor deze ondervertegenwoordigde populatie.","abstract_original":"BACKGROUND: The prevalence of hypertension among black African patients is high, and these patients usually need two or more medications for blood-pressure control. However, the most effective two-drug combination that is currently available for blood-pressure control in these patients has not been established. METHODS: In this randomized, single-blind, three-group trial conducted in six countries in sub-Saharan Africa, we randomly assigned 728 black patients with uncontrolled hypertension (≥140/90 mm Hg while the patient was not being treated or was taking only one antihypertensive drug) to receive a daily regimen of 5 mg of amlodipine plus 12.5 mg of hydrochlorothiazide, 5 mg of amlodipine plus 4 mg of perindopril, or 4 mg of perindopril plus 12.5 mg of hydrochlorothiazide for 2 months. Doses were then doubled (10 and 25 mg, 10 and 8 mg, and 8 and 25 mg, respectively) for an additional 4 months. The primary end point was the change in the 24-hour ambulatory systolic blood pressure between baseline and 6 months. RESULTS: The mean age of the patients was 51 years, and 63% were women. Among the 621 patients who underwent 24-hour blood-pressure monitoring at baseline and at 6 months, those receiving amlodipine plus hydrochlorothiazide and those receiving amlodipine plus perindopril had a lower 24-hour ambulatory systolic blood pressure than those receiving perindopril plus hydrochlorothiazide (between-group difference in the change from baseline, -3.14 mm Hg; 95% confidence interval [CI], -5.90 to -0.38; P = 0.03; and -3.00 mm Hg; 95% CI, -5.8 to -0.20; P = 0.04, respectively). The difference between the group receiving amlodipine plus hydrochlorothiazide and the group receiving amlodipine plus perindopril was -0.14 mm Hg (95% CI, -2.90 to 2.61; P=0.92). Similar differential effects on office and ambulatory diastolic blood pressures, along with blood-pressure control and response rates, were apparent among the three groups. CONCLUSIONS: These findings suggest that in black patients in sub-Saharan Africa, amlodipine plus either hydrochlorothiazide or perindopril was more effective than perindopril plus hydrochlorothiazide at lowering blood pressure at 6 months. (Funded by GlaxoSmithKline Africa Noncommunicable Disease Open Lab; CREOLE ClinicalTrials.gov number, NCT02742467.)."}