Comparison of Blood Pressure Control Rates Among Recommended Drug Selection Strategies for Initial Therapy of Hypertension.

Autor:	Gharaibeh KA; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA; kamelgharaibeh@yahoo.com., Turner ST; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA;, Hamadah AM; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA;, Chapman AB; Section of Nephrology, University of Chicago, Chicago, IL, USA;, Cooper-Dehoff RM; College of Pharmacy, University of Florida, Gainesville, FL, USA;, Johnson JA; College of Pharmacy, University of Florida, Gainesville, FL, USA;, Gums JG; College of Pharmacy, University of Florida, Gainesville, FL, USA;, Bailey KR; Divisions of Biostatistics and Biomedical Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA., Schwartz GL; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA;
Jazyk:	angličtina
Zdroj:	American journal of hypertension [Am J Hypertens] 2016 Oct; Vol. 29 (10), pp. 1186-94. Date of Electronic Publication: 2016 Jun 30.
DOI:	10.1093/ajh/hpw067
Abstrakt:	Background: Several approaches to initiation of antihypertensive therapy have been suggested. These include thiazide diuretics (TDs) as the first drug in all patients, initial drug selection based on age and race criteria, or therapy selection based on measures of plasma renin activity (PRA). It is uncertain which of these strategies achieves the highest control rate with monotherapy in Stage-I hypertension. We sought to compare control rates among these strategies. Methods: We used data from the Pharmacogenomic Evaluation of Antihypertensive Responses study (PEAR) to estimate control rates for each strategy: (i) TD for all, (ii) age- and race-based strategy: Hydrochlorothiazide (HCTZ) for all blacks and for whites ≥50 years and a renin-angiotensin system inhibitor (atenolol) for whites <50 years) or (iii) a PRA based strategy: HCTZ for suppressed PRA (<0.6ng/ml/h) and atenolol for non-suppressed PRA (≥0.6ng/ml/h) despite age or race. Hypertension was confirmed prior to treatment with HCTZ (148 blacks and 218 whites) or with atenolol (146 blacks and 221 whites). Results: In the overall sample, using clinic blood pressure (BP) response, the renin-based strategy was associated with the greatest control rate (48.9% vs. 40.8% with the age and race-based strategy (P = 0.0004) and 31.7% with the TD for all strategy (P < 0.0001)). The findings were similar using home or by 24-hour ambulatory BP responses and within each racial subgroup. Conclusions: A strategy for selection of initial antihypertensive drug therapy based on PRA was associated with greater BP control rates compared to a thiazide-for-all or an age and race-based strategy. (© American Journal of Hypertension, Ltd 2016. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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