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Lower birthweight may be associated with patient responses to certain antihypertensive medications

Blacks and people living in the Southeastern United States have a greater prevalence of high blood pressure (hypertension) than people living in other areas of the country. In addition, these groups have higher rates of low birthweight babies. Several studies have found an association between birthweight and blood pressure levels. A recent study, supported in part by the Agency for Healthcare Research and Quality (HS10871), links low birthweight with the use of different classes of antihypertensive medications.

Researchers at the Medical University of South Carolina examined the relationship between birthweight (obtained from birth certificates) and the use of various classes of antihypertensive medications (from pharmacy claims) in hypertensive Medicaid beneficiaries in South Carolina. Subjects had been treated for hypertension between 1993 and 1996.

During the study period, 59 percent of black patients and 59 percent of white patients had a prescription for one or more of the four classes of antihypertensive medications: diuretics, beta blockers (BBs), angiotensin converting enzyme (ACE) inhibitors, and calcium channel blockers (CCBs). Blacks were more likely to receive only diuretics than whites (65 vs. 52 percent), and whites were more likely than blacks to receive either an ACE inhibitor (28 vs. 20 percent) or BB (9 vs. 4 percent). CCBs constituted the sole medication for 9 to 10 percent of both whites and blacks.

No association was found between birthweight and the use of diuretics and/or BBs for any racial/ethnic group or either sex. However, black women who had lower birthweights were more likely to receive CCBs, even after adjustment for the total number of blood pressure medications. White men with high birthweights (who are more likely to become overweight and have more severe blood pressure late in life) and low birthweights were more likely to receive ACE inhibitors. These associations persisted after adjustment for likely confounders, which raises the possibility that birthweight in these demographic groups influences the efficacy of these antihypertensive agents.

In conclusion, the researchers note that these findings may demonstrate differential efficacy, which could provide the basis for more effective therapy in hypertensive patients by taking birthweight into consideration. They recommend that birthweight be considered in future studies that examine racial and geographic disparities in responses to various classes of antihypertensive medications.

See "Associations between birth weight and antihypertensive medication in black and white Medicaid recipients," by Daniel T. Lackland, Dr.P.H., Brent M. Egan, M.D., Holly E. Syddall, M.S., and David J. Barker, M.D., Ph.D., in the January 2002 Hypertension 39, pp. 179-183.

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