Clinical predictors of the response to short-term thiazide treatment in nondiabetic essential hypertensives

Abstract

Blood pressure (BP) response to diuretics is varied in hypertensive patients. This study aimed to identify the patients who may respond better or worse to thiazide diuretics. Nondiabetic patients with treated or untreated hypertension were evaluated if they did not take diuretics and their office systolic BP (SBP) 4140 mm Hg or diastolic BP (DBP) 490 mm Hg. Diet and life style modification were advised in addition to the concomitant medication, if there were, for 2 weeks. Additional hydrochlorothiazide 50 mg was given per day for another 2 weeks. Both office and 24-h ambulatory BP were checked. The changes of office SBP were used for the response to thiazide treatment. A total of 92 patients were enrolled. Compared with those in the quartile of worst response, patients in the quartile of best response were older with increased baseline SBP and pulse pressure (PP) and reduced heart rate. Reduced baseline awake, but not increased sleep DBP was associated with better response to thiazide. Besides, baseline age, SBP and PP were correlated to the response to thiazide treatment. Among these variables, increased baseline mean BP independently predicted the best and reduced SBP predicted the worst responders. Accordingly, patients with higher mean BP respond better to thiazide treatment no matter with or without concomitant medication. Patients with mainly diastolic hypertension with lower SBP responded poorly to thiazide treatment. The findings may help to individualized use of thiazide in nondiabetic hypertensives.

Hypertension subtypes modify metabolic response to thiazide diuretics

“…Compared to patients with the other subtypes, those with ISH had the most significant BP reduction. The findings were in accordance with our previous findings that patients with systolic hypertension respond better to thiazide treatment than those with diastolic hypertension and lower SBP [27]. Furthermore, patients with a lower baseline renin level are associated with greater BP reduction [28], which is also compatible with the notion that patients with relatively increased arteriolar resistance and volume accumulation may have a unique response to short-term thiazide treatment.…”

Genetic variation in renin predicts the effects of thiazide diuretics

“…The additional predictive value of REN on the effects of thiazide treatment was marginally and was mainly limited to individuals older than 60 years of age [10] and in African Americans and women [13]. In the current study, the response to thiazide treatment could be predicted by baseline PRA in a cohort of middle‐aged ethnic Chinese hypertensive patients with or without concomitant medications [14], suggesting the universal role of baseline PRA in the prediction of the response to thiazide diuretics even in patients with other concomitant medications. Further studies may be required to verify our findings in other ethnic cohorts.…”

“…Both environmental and genetic factors could modify the effects of antihypertensive drugs [9]. The response to thiazide diuretics did vary in different hypertensive cohorts [10][11][12][13][14]. It has been shown that the BP lowering response to hydrochlorothiazide (HCTZ) could be better with lower plasma renin activity (PRA), older age and black race [10][11][12].…”

A Novel SNP Associated with Nighttime Pulse Pressure in Young-Onset Hypertension Patients Could Be a Genetic Prognostic Factor for Cardiovascular Events in a General Cohort in Taiwan

“…For each recording, the study patients were recommended to go to bed at 23∶00 at night and wake up at 07∶00 in the morning. Ambulatory BP values were edited for artifacts using preselected criteria as described in previous studies [16] , and the daytime (7∶00 AM to 11∶00 PM) values were averaged, as were the nighttime values (11∶00 PM to 7∶00 AM). The patients were also asked to record their real sleeping time if it differed from the specified range.…”