[Role of renin profile and age in the choice of the therapeutic approach of arterial hypertension (author's transl)].
A group of 116 patients with grade I-II (W.H.O.) essential hypertension was studied. A diuretic treatment was instituted as a first step of therapy in 50 patients while the remaining 66 were firstly treated with beta-blockers. After 6 weeks of treatment the drugs were combined in those patients who did not achieve blood pressure control; this combination therapy was again maintained for 6 weeks and, if necessary, a vasodilating agent was added thereafter. The results show that with diuretic treatment alone diastolic blood pressure was brought to normal values (less than 95 mmHg) in 3/4 of our low renin patients, in 2/3 of normal renin and in 1/3 of high renin hypertensives. On the contrary among the group of patients treated with a beta-blocker alone more than half of the high and normal renin patients were controlled whereas this goal was achieved in only 1/4 of the low renin patients. Similar behaviour was observed subdividing the subjects in young (less than 35 yrs), middle-aged (36-49 yrs) and older (greater than 50 yrs) patients. In conclusion our data indicate that age must be taken into account in classifying hypertensive patients in renin subgroups. In addition if a renin-sodium profile is available, it can be useful in choosing between diuretics or beta-blocker as a first step treatment. Alternatively, younger patients are more likely to have better hypotensive responses with beta-blockers whereas in older patients antihypertensive treatment should preferentially be started with diuretics alone.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001262:Atenolol / Q000008:administration & dosage; D002752:Chlorthalidone / Q000008:administration & dosage; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008790:Metoprolol / Q000008:administration & dosage; D008875:Middle Aged; D011224:Prazosin / Q000008:administration & dosage; D012083:Renin / Q000097:blood*; D013015:Sotalol / Q000008:administration & dosage; D013148:Spironolactone / Q000008:administration & dosage
D000319:Adrenergic beta-Antagonists; D004232:Diuretics; D013148:Spironolactone; D001262:Atenolol; D013015:Sotalol; D012083:Renin; D008790:Metoprolol; D002752:Chlorthalidone; D011224:Prazosin
Ruolo del profilo reninico e dell'età nella scelta dell'approccio terapeutico dell'ipertensione arteriosa.