American Journal of Hypertension - Abstract of article: Pressor Responses to Antihypertensive Drug Types

Therapeutics
Subject Category: Therapeutics

American Journal of Hypertension 2010; doi:10.1038/ajh.2010.114

Pressor Responses to Antihypertensive Drug Types
Michael H. Alderman1, Hillel W. Cohen2, Jean E. Sealey3,4 and John H. Laragh4

1Department of Epidemiology, Albert Einstein College of Medicine, Bronx, New York, USA
2Department of Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
3Department of Medicine, Weill Cornell Medical College, New York, New York, USA
4Cardiovascular Center, Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
Correspondence: Michael H. Alderman, (michael.alderman@einstein.yu.edu)

Received 12 February 2010; First Decision 6 March 2010; Accepted 21 April 2010; Published online 19 August 2010.

Abstract
Background
Pressor responses to antihypertensive drugs are not addressed in treatment guidelines although they have been described in various clinical situations. We now report the incidence of pressor responses to initiation of monotherapy using four antihypertensive drug types, and the influence of plasma renin activity (PRA) status, among participants in a worksite-based antihypertensive treatment program.

Methods
Systolic blood pressure (SBP) response was evaluated among 945 participants with no prior treatment who were given either a diuretic or calcium-channel blocker (natriuretic antivolume V drugs, n = 537) or a β-blocker or angiotensin-converting enzyme (ACE) inhibitor (antirenin R drugs n = 408). PRA was categorized by low, middle, and high tertiles (L, M, and H). SBP rise ≥10 mm Hg was considered pressor.

Results
More pressor responses occurred with R than V drugs (11% vs. 5%, P = 0.001). L, M, and H renin tertiles had similar frequencies with V drugs (6, 4, and 6%), but low and middle tertiles given R had greater pressor frequencies (17% P = 0.003 vs. V and 10% P = 0.02 vs. V). Treatment SBP ≥160 mm Hg occurred more frequently with R than V drugs (19% vs. 13%; P = 0.007); moreover, in the lowest renin tertile 35% R vs. 13% V (P = 0.001) had SBP ≥160 mm Hg. Treatment SBP <130 mm Hg was more frequent in V patients in the lowest tertile (18% vs. 5%; P = 0.003), and in R patients in the highest tertile (26% vs. 12%, P = 0.002).

Conclusions
Pressor responses to antihypertensive monotherapy occur sufficiently frequently to be of concern, especially in lower renin patients given a β-blocker or ACE inhibitor (ACEI).

American Journal of Hypertension 2010; doi:10.1038/ajh.2010.114

Keywords: anti hypertensive drugs; blood pressure; hypertension; pressor responses; renin

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American Journal of Hypertension - Abstract of article: Pressor Responses to Antihypertensive Drug Types