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
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.