title: Night blood pressure responses to atenolol and hydrochlorothiazide in black and white patients with essential hypertension.
abstract: BACKGROUND
  Night blood pressure (BP) predicts patient outcomes. Variables associated with night BP response to antihypertensive agents have not been fully evaluated in essential hypertension.
  
  
  METHODS
  We sought to measure night BP responses to hydrochlorothiazide (HCTZ), atenolol (ATEN), and combined therapy using ambulatory blood pressure (ABP) monitoring in 204 black and 281 white essential hypertensive patients. Initial therapy was randomized; HCTZ and ATEN once daily doses were doubled after 3 weeks and continued for 6 more weeks with the alternate medication added for combined therapy arms. ABP was measured at baseline and after completion of each drug. Night, day, and night/day BP ratio responses (treatment - baseline) were compared in race/sex subgroups.
  
  
  RESULTS
  Baseline night systolic BP and diastolic BP, and night/day ratios were greater in blacks than whites (P < 0.01, all comparisons). Night BP responses to ATEN were absent and night/day ratios increased significantly in blacks (P < 0.05). At the end of combined therapy, women, blacks, and those starting with HCTZ as opposed to ATEN had significantly greater night BP responses (P < 0.01). Variables that significantly associated with ATEN response differed from those that associated with HCTZ response and those that associated with night BP response differed from those that associated with day BP response.
  
  
  CONCLUSIONS
  In summary, after completion of HCTZ and ATEN therapy, women, blacks, and those who started with HCTZ had greater night BP responses. Reduced night BP response and increased night/day BP ratios occured with ATEN in blacks. Given the prognostic significance of night BP, strategies for optimizing night BP antihypertensive therapy should be considered.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier NCT00246519.
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, GA.
authors.forename: Arlene B
authors.initials: AB
authors.lastname: Chapman
authors.forename: George
authors.initials: G
authors.lastname: Cotsonis
authors.forename: Vishal
authors.initials: V
authors.lastname: Parekh
authors.forename: Gary L
authors.initials: GL
authors.lastname: Schwartz
authors.forename: Yan
authors.initials: Y
authors.lastname: Gong
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Turner
authors.forename: John G
authors.initials: JG
authors.lastname: Gums
authors.forename: Amber L
authors.initials: AL
authors.lastname: Beitelshees
authors.forename: Rhonda
authors.initials: R
authors.lastname: Cooper-DeHoff
authors.forename: Eric
authors.initials: E
authors.lastname: Boerwinkle
authors.forename: Julie A
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D044383:Black People; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D004359:Drug Therapy, Combination; D000075222:Essential Hypertension; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D044465:White People
chemical_list: D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide; D001262:Atenolol
keywords: ambulatory blood pressure; atenolol; blood pressure; hydrochlorothiazide; hypertension; night/day ratio.