Age-Race Subgroup Compared With Renin Profile as Predictors of Blood Pressure Response to Antihypertensive Therapy

Abstract

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 (Ͻ90 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 lowand 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 (PϽ.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.

Annual Incidence of Nephrolithiasis among Children and Adults in South Carolina from 1997 to 2012

“…treating nephrolithiasis among younger, nonwhite populations (25,26). New trials conducted among populations that reflect the contemporary incidence of nephrolithiasis are needed.…”

Why is plasma renin activity lower in populations of African origin?

“…However, more direct investigations of pre-treatment renin status in hypertensive blacks in relation to blood pressure response have demonstrated that the pretreatment PRA was not a particularly effective index of subsequent blood pressure response to pharmacological treatment. 24,[86][87][88][89] Nevertheless, other studies have demonstrated that the blood pressure reduction to short term sodium restriction was greater in blacks compared with whites; moreover, in the blacks, the greater reduction in blood pressure was significantly related, at least in part, to the decreased responsiveness of the renin-angiotensin system. 12 …”

A Noninferiority Comparison of Valsartan/Hydrochlorothiazide Combination Versus Amlodipine in Black Hypertensives

“…This supposed lack of effect has been attributed to the misperception that all of these patients have low-renin, salt-sensitive, volume-dependent hypertension. 5,6 In fact, blacks represent a heterogeneous population with respect to renin levels, 7 which may not accurately predict response to treatment. 8,9 Any difference in effect from other classes of antihypertensive agents is eliminated when angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are used in higher doses or in combination with a diuretic.…”