[Relationship between sympathetic activity and response to treatment with atenolol in hypertensive patients. Investigation group of the study of efficiency and tolerance of atenolol in hypertensive patients with increase in the sympathetic activity].
BACKGROUND
Therapeutical response to antihypertensive treatment is poorly predicted by individual clinical or biochemical characteristics. Some preliminary data indicate that therapeutical response to atenolol might depend on physical and/or sympathetic activity. The aim of the present study was to evaluate the blood pressure response to atenolol depending on physical and sympathetic activity.


METHODS
One thousand one hundred forty hypertensive patients were treated with the beta adrenorecepetor blocker atenolol in an open fashion during 3 months. Before the beginning of the treatment, we evaluated current weekly physical activity (direct interview), as well as sympathetic activity (direct interview and baseline heart rate).


RESULTS
Age or physical activity did not correlate with blood pressure response to atenolol. Conversely, hypertensive patients with symptoms suggesting sympathetic overactivity (three or more of the following symptoms: palpitations, anxiety, diaphoresis, headache, tremor or weakness; n = 456), showed a more pronounced decrease in systolic (27.7 [13.4] vs 25.8 [14.3] mmHg; p = 0.0226) and diastolic (17.6 [8.3] vs 15.5 [8.6] mmHg; p = 0.0001) blood pressures (SBP and DBP), with respect to the remaining hypertensive patients (n = 719). Moreover, we found a statistically significant correlation between blood pressure fall with atenolol and baseline heart rate (r = 0.107, P < 0.001 for SBP, and r = 0.142, p < 0.001 for DBP).


CONCLUSIONS
Baseline tachycardia or symptoms suggesting anxiety, emotional tension or sympathetic overactivity are associated with a more pronounced blood pressure fall to antihypertensive treatment with atenolol. These circumstances may play a role when choosing a new antihypertensive therapy.
de la Sierra
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Unidad de HTA, Hospital Clínic i Provincial, Barcelona. iserte@medicina.ub.es
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D001262:Atenolol / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology; D011795:Surveys and Questionnaires; D013564:Sympathetic Nervous System / Q000502:physiology*; D013565:Sympatholytics / Q000627:therapeutic use*; D014202:Tremor / Q000175:diagnosis / Q000523:psychology
D013565:Sympatholytics; D001262:Atenolol
Relaciones entre la actividad simpática y la respuesta de la presión arterial al tratamiento antihipertensivo con atenolol. Grupo de Investigadores del estudio EFITSI Eficacia y Tolerancia de Atenolol en Pacientes Hipertensos con Aumento de la Actividad Simpática.