title: Pressor response to initial blood pressure monotherapy is associated with cardiovascular mortality.
abstract: BACKGROUND
  A paradoxical pressor systolic response to initial antihypertensive monotherapy has been observed in 8% of hypertensive patients. The long-term consequences of this finding are unknown.
  
  
  METHODS
  We included 945 hypertensive patients with baseline systolic blood pressure (SBP) ≥140mm Hg. A 4-week washout period free of antihypertensive drugs was allowed for those already on treatment at entry. Mortality outcomes were ascertained from the National Death Index. Subjects were categorized by SBP response into depressor (≥10mm Hg fall), nonresponder, and pressor (≥10mm Hg rise) categories.
  
  
  RESULTS
  There were 268 fatalities. Of these, 100 (37%) were from cardiovascular disease (CVD), of which 70 (70%) were due to coronary artery disease (CAD). A pressor response was associated with higher SBP at 1 year compared with the nonresponder or depressor response (141 vs. 136 vs. 136mm Hg). CVD mortality was greater in pressors than depressors (hazard ratio (HR) = 3.0; 95% confidence interval (CI) = 1.4-6.4; P = 0.004], as was CAD (HR = 3.1; 95% CI = 1.4-6.8; P < 0.01) and all-cause mortality (HR = 1.7; 95% CI = 1.1-2.6; P = 0.02), after adjusting for 1-year SBP and other possible confounders.
  
  
  CONCLUSIONS
  We found the incidence of a pressor response to monotherapy at 3 months was significantly, specifically, and independently associated with higher subsequent cardiovascular mortality.
authors.affiliation: New York Presbyterian-Weill Cornell Medical Center, New York, New York; mdg9009@nyp.org.
authors.forename: Maday C
authors.initials: MC
authors.lastname: Gonzalez
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Alderman
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000009:adverse effects*; D002121:Calcium Channel Blockers / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D004232:Diuretics / Q000009:adverse effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000188:drug therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D014661:Vasoconstriction
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics
keywords: blood pressure; cardiovascular disease; coronary artery disease; hypertension; mortality; plasma renin activity; pressor response.