Renin profile as a predictor of blood pressure response to antihypertensive therapy in 1292 patients: Results of the VA cooperative study.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Oct) 8:321A 1997
The response to antihypertensive therapy is partially related to the renin status of hypertensive subjects. The recent large clinical trial of hypertensive subjects which compared six classes of drugs (VA cooperative trial) allowed the investigators an opportunity to investigate if the baseline renin status played a role in response to drug therapy. A total of 1292 men with baseline diastolic BP of 95 to 109 mmHg were randomized to one of six classes of antihypertensive drugs or placebo. Therapy was titrated by protocol to achieve a goal diastolic BP of less than 90 mmHg.
The baseline renin status was measured and the response rates in each drug group calculated. The authors found that irrespective of renin class the best response rates were seen with clonidine and diltiazem. Diuretics and alpha blockers achieved the highest response rate in those with low and medium renin levels. Not unexpectedly ACE inhibitor achieved the best results in those with medium and high renin levels. The response rate in low renin patients treated with diuretics and high renin patients treated with B-blocker or ACE inhibitor was higher than that of high renin patients treated with diuretics and low renin patients treated with B-Blockers or ACE inhibitors.
Comment: These data support the idea that baseline renin status may help in deciding the class of pharmacological therapy for hypertension. However the measurement of renin levels in essential hypertensive subjects is not currently routinely done. In general older patients and African Americans tend to be in the lower renin subgroups and tend to respond better to diuretics, all else being equal. (George Mansoor, M.D., University of Connecticut)
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ASN 30th Annual Meeting, San Antonio
H: Drug therapy : Chronotherapeutics