title: Can we identify response markers to antihypertensive drugs? First results from the IDEAL Trial.
abstract: Current antihypertensive strategies do not take into account that individual characteristics may influence the magnitude of blood pressure (BP) reduction. Guidelines promote trial-and-error approaches with many different drugs. We conducted the Identification of the Determinants of the Efficacy of Arterial blood pressure Lowering drugs (IDEAL) Trial to identify factors associated with BP responses to perindopril and indapamide. IDEAL was a cross-over, double-blind, placebo-controlled trial, involving four 4-week periods: indapamide, perindopril and two placebo. Eligible patients were untreated, hypertensive and aged 25-70 years. The main outcome was systolic BP (SBP) response to drugs. The 112 participants with good compliance had a mean age of 52. One in every three participants was a woman. In middle-aged women, the SBP reduction from drugs was -11.5 mm Hg (indapamide) and -8.3 mm Hg (perindopril). In men, the response was significantly smaller: -4.8 mm Hg (indapamide) and -4.3 (perindopril) (P for sex differences 0.001 and 0.015, respectively). SBP response to perindopril decreased by 2 mm Hg every 10 years of age in both sexes (P=0.01). The response to indapamide increased by 3 mm Hg every 10 years of age gradient in women (P=0.02). Age and sex were important determinants of BP response for antihypertensive drugs in the IDEAL population. This should be taken into account when choosing drugs a priori.
authors.affiliation: 1] Centre d'Investigations Cliniques CIC201 Inserm and Department of Clinical Pharmacology, Hospices Civils de Lyon, Lyon, France [2] UMR 5558, CNRS, Villeurbanne, France [3] Université Claude Bernard Lyon1, Lyon, France.
authors.forename: F
authors.initials: F
authors.lastname: Gueyffier
authors.affiliation: 1] UMR 5558, CNRS, Villeurbanne, France [2] Université Claude Bernard Lyon1, Lyon, France [3] Service de Biostatistique, Hospices Civils de Lyon, Lyon, France.
authors.forename: F
authors.initials: F
authors.lastname: Subtil
authors.affiliation: Service de Pharmacologie Clinique, Centre Hospitalier Régional et Universitaire de Tours, UMR 7292, CNRS, Université François Rabelais, Tours, France.
authors.forename: T
authors.initials: T
authors.lastname: Bejan-Angoulvant
authors.affiliation: 1] Université Claude Bernard Lyon1, Lyon, France [2] Department of General Practice, Université Claude Bernard Lyon1, Lyon, France [3] Sciences et Société; Historicité, Éduction et Pratiques (S2HEP), Villeurbanne, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Zerbib
authors.affiliation: 1] Department of Cardiology, Centre Hospitalier Universitaire, Grenoble, France [2] INSERM 1039, Bioclinic Radiopharmaceutics Laboratory, Université Joseph Fourier, Grenoble, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Baguet
authors.affiliation: Centre d'Investigations Cliniques Plurithématique, CIC-P-Inserm CHU de Nancy, Institut Lorrain du cœur et des vaisseaux Louis Mathieu, Université Henri Poincaré Nancy, 4 allée du Morvan, Vandœuvre lès Nancy, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Boivin
authors.affiliation: 1] Department of General Practice, Faculté de Médecine, Rouen University, Rouen, France [2] CIC Inserm 0204 CHU de Rouen, Rouen, France.
authors.forename: A
authors.initials: A
authors.lastname: Mercier
authors.affiliation: Laboratoire d'Explorations Fonctionnelles Vasculaires, CHU Angers, Angers, France.
authors.forename: G
authors.initials: G
authors.lastname: Leftheriotis
authors.affiliation: Cardiology department, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Montpellier, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Gagnol
authors.affiliation: Department of Nephrology and Hypertension, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Fauvel
authors.affiliation: 1] Centre d'Investigations Cliniques CIC201 Inserm and Department of Clinical Pharmacology, Hospices Civils de Lyon, Lyon, France [2] UMR 5558, CNRS, Villeurbanne, France [3] Université Claude Bernard Lyon1, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Giraud
authors.affiliation: Exploration Fonctionnelle Endocrinienne et Métabolique, Centre de Biologie Nord, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Bricca
authors.affiliation: 1] Université Claude Bernard Lyon1, Lyon, France [2] Service de Biostatistique, Hospices Civils de Lyon, Lyon, France.
authors.forename: D
authors.initials: D
authors.lastname: Maucort-Boulch
authors.affiliation: Department of General Practice, Université Claude Bernard Lyon1, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Erpeldinger
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D062186:Arterial Pressure / Q000187:drug effects*; D018592:Cross-Over Studies; D004232:Diuretics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005602:France; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007190:Indapamide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D020913:Perindopril / Q000627:therapeutic use*; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004232:Diuretics; D007190:Indapamide; D020913:Perindopril
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