title: Low-grade inflammation and ambulatory blood pressure response to antihypertensive treatment: the ALPHABET study.
abstract: BACKGROUND
  We examined whether the level of highsensitivity C-reactive protein (hsCRP), a marker of low-grade inflammation, predicted the response of clinic and ambulatory blood pressure (BP) to antihypertensive treatment.
  
  
  METHODS
  A randomized, open-label, multicenter trial was performed in 88 hypertensive patients (mean age = 63.4 years) allocated to receive losartan 50 mg or amlodipine 5 mg for 4 weeks, and each treatment was changed to losartan 50 mg/hydrochlorothiazide (HCTZ) 12.5 mg in combination or amlodipine 10 mg for a further 4 weeks. Clinic and ambulatory BP were measured before and after 8 weeks of treatment, and hsCRP was measured at baseline.
  
  
  RESULTS
  The patients were divided into groups with hsCRP levels above and below the median (0.47 mg/L) for the study population. In the total population, 24-hour systolic BP (SBP) (P = 0.03) and daytime SBP (P = 0.01) were significantly higher in the above-median hsCRP group after 8 weeks of treatment. In multivariable regression analysis, baseline hsCRP was a significant determinant of the percentage change in daytime SBP (β = 0.29; P = 0.02) in the total population. In the losartan/HCTZ treatment group, changes in 24-hour SBP, daytime SBP, and diastolic BP were significantly smaller in the above-median hsCRP group than the below-median hsCRP group, whereas the amlodipine group did not show these differences.
  
  
  CONCLUSIONS
  Baseline low-grade inflammation in patients with hypertension was associated with a poor ambulatory BP response, especially with losartan/HCTZ treatment. Initial measurement of hsCRP could be useful for selection of an appropriate antihypertensive drug.
authors: Yanai Municipal Heigun Clinic, Yamaguchi, Japan.
authors: Motoki
authors: M
authors: Fukutomi
authors: Satoshi
authors: S
authors: Hoshide
authors: Kazuo
authors: K
authors: Eguchi
authors: Tomonori
authors: T
authors: Watanabe
authors: Kazuomi
authors: K
authors: Kario
mesh_terms: D017311:Amlodipine / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007249:Inflammation / Q000150:complications / Q000209:etiology*; D019808:Losartan / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; C505809:hydrochlorothiazide, losartan drug combination; D006852:Hydrochlorothiazide; D017311:Amlodipine; D019808:Losartan
keywords: ambulatory blood pressure; angiotensin receptor blocker; antihypertensive response; blood pressure; diuretic; high-sensitivity C-reactive protein; hypertension.