Journal
AMERICAN JOURNAL OF HYPERTENSION
Volume 29, Issue 10, Pages 1186-1194Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ajh/hpw067
Keywords
antihypertensive drug therapy; atenolol; beta-blocker; blood pressure; hydrochlorothiazide; hypertension; plasma renin activity; thiazide diuretic
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Funding
- Pharmacogenomics Research Network [PGRN U01 GM074492]
- National Center for Advancing Translational Sciences Clinical and Translational Science Award [NIH NCATS: UL1 TR000064, UL1TR000454, UL1 TR000135]
- Mayo Foundation
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Several approaches to initiation of antihypertensive therapy have been suggested. These include thiazide diuretics (TDs) as the first drug in all patients, initial drug selection based on age and race criteria, or therapy selection based on measures of plasma renin activity (PRA). It is uncertain which of these strategies achieves the highest control rate with monotherapy in Stage-I hypertension. We sought to compare control rates among these strategies. We used data from the Pharmacogenomic Evaluation of Antihypertensive Responses study (PEAR) to estimate control rates for each strategy: (i) TD for all, (ii) age- and race-based strategy: Hydrochlorothiazide (HCTZ) for all blacks and for whites a parts per thousand yen50 years and a renin-angiotensin system inhibitor (atenolol) for whites < 50 years) or (iii) a PRA based strategy: HCTZ for suppressed PRA (< 0.6ng/ml/h) and atenolol for non-suppressed PRA (a parts per thousand yen0.6ng/ml/h) despite age or race. Hypertension was confirmed prior to treatment with HCTZ (148 blacks and 218 whites) or with atenolol (146 blacks and 221 whites). In the overall sample, using clinic blood pressure (BP) response, the renin-based strategy was associated with the greatest control rate (48.9% vs. 40.8% with the age and race-based strategy (P = 0.0004) and 31.7% with the TD for all strategy (P < 0.0001)). The findings were similar using home or by 24-hour ambulatory BP responses and within each racial subgroup. A strategy for selection of initial antihypertensive drug therapy based on PRA was associated with greater BP control rates compared to a thiazide-for-all or an age and race-based strategy.
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