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Age-Race Subgroup Compared With Renin Profile as Predictors of Blood Pressure Response to Antihypertensive Therapy
Richard A. Preston, MD, MBA;
Barry J. Materson, MD, MBA;
Domenic J. Reda, MS;
David W. Williams, MS;
Robert J. Hamburger, MD;
William C. Cushman, MD;
Robert J. Anderson, PhD;
for the Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents
JAMA. 1998;280:1168-1172.
Context.— Renin profiling and age-race subgroup may help select single-drug therapy for stage 1 and stage 2 hypertension.
Objective.— To compare the plasma renin profiling and age-race subgroup methods as predictors of response to single-drug therapy in men with stage 1 and 2 hypertension as defined by the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.
Design.— The Veterans Affairs Cooperative Study on Single-Drug Therapy of Hypertension, a randomized controlled trial.
Setting.— Fifteen Veterans Affairs hypertension centers.
Patients.— A total of 1105 ambulatory men with entry diastolic blood pressure (DBP) of 95 to 109 mm Hg, of whom 1031 had valid plasma and urine samples for renin profiling.
Interventions.— Randomization to 1 of 6 antihypertensive drugs: hydrochlorothiazide, atenolol, captopril, clonidine, diltiazem (sustained release), or prazosin.
Main Outcome Measure.— Treatment response as assessed by percentage achieving goal DBP (<90 mm Hg) in response to a single drug that corresponded to patients' renin profile vs a single drug that corresponded to patients' age-race subgroup.
Results.— Clonidine and diltiazem had consistent response rates regardless of renin profile (76%, 67%, and 80% for low, medium, and high renin, respectively, for clonidine and 83%, 82%, and 83%, respectively, for diltiazem for patients with baseline DBP of 95-99 mm Hg). Hydrochlorothiazide and prazosin were best in low- and medium-renin profiles; captopril was best in medium- and high-renin profiles (low-, medium-, and high-renin response rates were 82%, 78%, and 14%, respectively, for hydrochlorothiazide; 88%, 67%, and 40%, respectively, for prazosin; and 51%, 83%, and 100%, respectively, for captopril for patients with baseline DBP of 95-99 mm Hg). Response rates for patients with baseline DBP of 95 to 99 mm Hg by age-race subgroup ranged from 70% for clonidine to 90% for prazosin for younger black men, from 50% for captopril to 97% for diltiazem for older black men, from 70% for hydrochlorothiazide to 92% for atenolol for younger white men, and from 84% for hydrochlorothiazide to 95% for diltiazem for older white men. Patients with a correct treatment for their renin profile but incorrect for age-race subgroup had a response rate of 58.7%; patients with an incorrect treatment for their renin profile but correct for age-race subgroup had a response rate of 63.1% (P = .30). After controlling for DBP and interactions with treatment group, age-race subgroup (P<.001) significantly predicted response to single-drug therapy, whereas renin profile was of borderline significance (P = .05).
Conclusions.— In these men with stage 1 and stage 2 hypertension, therapeutic responses were consistent with baseline renin profile, but age-race subgroup was a better predictor of response.
From the Division of Clinical Pharmacology, Department of Medicine (Dr Preston) and the Department of Medicine (Dr Materson), University of Miami School of Medicine, Miami, Fla; Cooperative Studies Program, Edward Hines Jr Veterans Affairs Hospital, Hines, Ill (Messrs Reda and Williams and Dr Anderson); Renal Section, Veterans Affairs Medical Center, Boston, Mass (Dr Hamburger); and Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, Tenn (Dr Cushman).
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