title: Plasma renin activity predicts blood pressure responses to beta-blocker and thiazide diuretic as monotherapy and add-on therapy for hypertension.
abstract: BACKGROUND
  Age and race categories or renin profiling have been recommended to predict blood pressure responses to monotherapy with a beta-blocker or thiazide diuretic. Whether these or other characteristics predict blood pressure responses when the drugs are administered as add-on therapy is uncertain.
  
  
  METHODS
  We evaluated predictors of blood pressure response in 363 men and women < or =65 years of age with primary hypertension (152 blacks, 211 whites), 86 of whom (24%) were untreated and 277 of whom (76%) were withdrawn from previous antihypertensive drugs before randomization to either atenolol followed by addition of hydrochlorothiazide (N = 180) or hydrochlorothiazide followed by addition of atenolol (N = 183). Responses were determined by home blood pressure averages before and after each drug administration. Race, age, plasma renin activity, and other characteristics including pretreatment blood pressure levels were incorporated into linear regression models to quantify their contributions to prediction of blood pressure responses.
  
  
  RESULTS
  Plasma renin activity and pretreatment blood pressure level consistently contributed to prediction of systolic and diastolic responses to each drug administered as mono- and as add-on therapy. Higher plasma renin activity was consistently associated with greater blood pressure responses to atenolol and lesser responses to hydrochlorothiazide. The predictive effects of plasma renin activity were statistically independent of race, age, and other characteristics.
  
  
  CONCLUSIONS
  Plasma renin activity and pretreatment blood pressure level predict blood pressure responses to atenolol and hydrochlorothiazide administered as mono- and as add-on therapy in men and women < or =65 years of age.
authors: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA. htndoc@mayo.edu
authors: Stephen T
authors: ST
authors: Turner
authors: Gary L
authors: GL
authors: Schwartz
authors: Arlene B
authors: AB
authors: Chapman
authors: Amber L
authors: AL
authors: Beitelshees
authors: John G
authors: JG
authors: Gums
authors: Rhonda M
authors: RM
authors: Cooper-DeHoff
authors: Eric
authors: E
authors: Boerwinkle
authors: Julie A
authors: JA
authors: Johnson
authors: Kent R
authors: KR
authors: Bailey
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D015992:Body Mass Index; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012083:Renin / Q000097:blood*; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D049993:Sodium Chloride Symporter Inhibitors; D012083:Renin