Renin profiling and age-race subgroup may help select single-drug therapy
for stage 1 and stage 2 hypertension.
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.
The Veterans Affairs Cooperative Study on Single-Drug Therapy of Hypertension,
a randomized controlled trial.
Fifteen Veterans Affairs hypertension centers.
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
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.
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).
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.