Age-race subgroup vs renin profile as predictors of blood pressure response to antihypertensive therapy in 292 patients: Results of the VA cooperative study.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:321A 1997
The choice of proper single-drug therapy in treating essential hypertension may have substantial impact on treatment efficacy, quality of life and cost. In an earlier communication this group demonstrated that age and race must be considered when choosing a single therapy for essential hypertension (Materson et al, NEJM, 328:914-21, 1993 correction: ibid., 330:1689, 1994).
In this study the VA Cooperative Study Group extended their previous work by analyzing blood pressure (BP) response to single therapy when the drug was chosen based on age-race subgroups vs. renin profiling. Within the frame of a double blinded prospective design, ambulatory males with diastolic BP of 95-109 were assigned to low, medium and high renin (n=642) or young black (YB), old black (OB), young white (YW), old white (OW) subgroups. The cut-off point for age was 60 year. The medication was randomly chosen from the following options: low renin: Diltiazem (D), prazosin (P), hydrochlorothiazide (T); high renin: atenolol (A), captopril (C); YB: D or A, OB: D or T, YW: C or A, OW: A or D. Treatment response was defined as DBP<90 during the titration phase (4-8 wk.) or DBP<95 in the maintenance phase (1 y). Using these criteria, when the drug was chosen based on rennin profiling, 62.9% of patients responded vs. 71.6% response when the drug was chosen based on age-race subgroups (p=0.78). The overall decrease in systolic BP was 12.7 ±11.4 vs. 12.8 ± 10.6 mmHg in the rennin profile groups and age-race group respectively. The corresponding values for the DBP were 11.5 ± 6.9 and 13.0 ± 6.2.
Comment: The results suggest that the age-race method or renin profiling can facilitate choosing a single drug for the treatment of essential hypertension equally well. It would be interesting to see whether combining the two methods would increase the efficacy of single-drug therapy. Because of introducing multiple new subgroups (OB with low/normal/high renin, etc.) such analysis may require much more patients to assure proper statistical power.
(Laszlo Hopp, Alfred I. duPont Hospital for Children; Wilmington, DE)
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ASN 30th Annual Meeting, San Antonio
H: Drug therapy : Chronotherapeutics
H: Special problems : Ethnic populations