American Journal of Hypertension - Abstract of article: Plasma Renin Activity Predicts Blood Pressure Responses to [beta]-Blocker and Thiazide Diuretic as Monotherapy and Add-On Therapy for Hypertension

Therapeutics
Subject Category: Therapeutics

American Journal of Hypertension 2010; doi:10.1038/ajh.2010.98

Plasma Renin Activity Predicts Blood Pressure Responses to β-Blocker and Thiazide Diuretic as Monotherapy and Add-On Therapy for Hypertension
Stephen T. Turner1, Gary L. Schwartz1, Arlene B. Chapman2, Amber L. Beitelshees3, John G. Gums4, Rhonda M. Cooper-DeHoff4, Eric Boerwinkle5, Julie A. Johnson4 and Kent R. Bailey1

1Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
2Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
3University of Maryland School of Medicine, College of Medicine, Baltimore, Maryland, USA
4College of Pharmacy and Medicine and Center for Pharmacogenomics, University of Florida, Gainesville, Florida, USA
5Human Genetics and Institute of Molecular Medicine, University of Texas Health Science Center, Houston, Texas, USA
Correspondence: Stephen T. Turner, (htndoc@mayo.edu)

Received 7 January 2010; First Decision 20 February 2010; Accepted 20 March 2010; Published online 19 August 2010.

Abstract
Background
Age and race categories or renin profiling have been recommended to predict blood pressure responses to monotherapy with a β-blocker or thiazide diuretic. Whether these or other characteristics predict blood pressure responses when the drugs are administered as add-on therapy is uncertain.

Methods
We evaluated predictors of blood pressure response in 363 men and women ≤65 years of age with primary hypertension (152 blacks, 211 whites), 86 of whom (24%) were untreated and 277 of whom (76%) were withdrawn from previous antihypertensive drugs before randomization to either atenolol followed by addition of hydrochlorothiazide (N = 180) or hydrochlorothiazide followed by addition of atenolol (N = 183). Responses were determined by home blood pressure averages before and after each drug administration. Race, age, plasma renin activity, and other characteristics including pretreatment blood pressure levels were incorporated into linear regression models to quantify their contributions to prediction of blood pressure responses.

Results
Plasma renin activity and pretreatment blood pressure level consistently contributed to prediction of systolic and diastolic responses to each drug administered as mono- and as add-on therapy. Higher plasma renin activity was consistently associated with greater blood pressure responses to atenolol and lesser responses to hydrochlorothiazide. The predictive effects of plasma renin activity were statistically independent of race, age, and other characteristics.

Conclusions
Plasma renin activity and pretreatment blood pressure level predict blood pressure responses to atenolol and hydrochlorothiazide administered as mono- and as add-on therapy in men and women ≤65 years of age.

American Journal of Hypertension 2010; doi:10.1038/ajh.2010.98

Keywords: antihypertensive drug therapy; blood pressure; hypertension; plasma renin activity; thiazide diuretic; β-blocker

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American Journal of Hypertension - Abstract of article: Plasma Renin Activity Predicts Blood Pressure Responses to [beta]-Blocker and Thiazide Diuretic as Monotherapy and Add-On Therapy for Hypertension