title: The role of plasma renin activity, age, and race in selecting effective initial drug therapy for hypertension.
abstract: BACKGROUND
  Strategies for initial drug therapy of hypertension are a thiazide diuretic for all or drug selection based on age/race criteria or on plasma renin activity (PRA). It is uncertain which of these strategies will achieve the highest control rate among patients with stage 1 essential hypertension. We sought to compare control rates among 3 drug selection strategies: (i) thiazide diuretic for all, (ii) thiazide diuretic for all black subjects and white subjects aged ≥50 years and a renin-angiotensin system blocker for white subjects aged <50 years, or (iii) thiazide diuretic for PRA < 0.6ng/ml/h (suppressed PRA) and a renin-angiotensin system blocker for PRA ≥ 0.6ng/ml/h (nonsuppressed PRA).
  
  
  METHODS
  Blood pressure responses from the Genetic Epidemiology of Responses to Antihypertensives (GERA) study were used to determine control rates for each of the 3 strategies. In GERA, hypertensive adults were treated with hydrochlorothiazide (n = 286 black subjects and 284 white subjects) or with candesartan (n = 248 black subjects and 278 white subjects).
  
  
  RESULTS
  In the overall sample, the PRA strategy was associated with the highest control rate of 69.4% vs. 61.3% with the age/race strategy (P < 0.001) and 53.8% with the thiazide for all strategy (P < 0.001). This was also true in each racial subgroup (in black subjects: 62.1% vs. 55.2% for the other 2 strategies, P = 0.02; in white subjects: 76.3% vs. 67.1% with the age/race strategy (P < 0.001) and 52.4% with the thiazide for all strategy (P < 0.001)).
  
  
  CONCLUSIONS
  This exploratory analysis suggests that choice of initial therapy for hypertension using a PRA strategy may be associated with higher control rates than alternative strategies recommended in current guidelines.
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN ,USA. gschwartz@mayo.edu
authors.forename: Gary L
authors.initials: GL
authors.lastname: Schwartz
authors.forename: Kent
authors.initials: K
authors.lastname: Bailey
authors.forename: Arlene B
authors.initials: AB
authors.lastname: Chapman
authors.forename: Eric
authors.initials: E
authors.lastname: Boerwinkle
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Turner
mesh_terms: D000328:Adult; D000367:Age Factors; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D044383:Black People; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011863:Radioimmunoassay; D012083:Renin / Q000097:blood / Q000502:physiology*; D012189:Retrospective Studies; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome; D044465:White People
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D049993:Sodium Chloride Symporter Inhibitors; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D012083:Renin; C081643:candesartan
keywords: blood pressure; control rate; hypertension; pharmacotherapy.