title: Correlations of plasma renin activity and aldosterone concentration with ambulatory blood pressure responses to nebivolol and valsartan, alone and in combination, in hypertension.
abstract: After demonstration of the antihypertensive efficacy of the combination of the beta-blocker nebivolol and the angiotensin receptor blocker valsartan in an 8-week, randomized, placebo-controlled trial (N = 4161), we now report the effects of this treatment on the renin-angiotensin-aldosterone system in a substudy (n = 805). Plasma renin activity increased with valsartan (54%-73%) and decreased with nebivolol (51%-65%) and the combination treatment (17%-39%). Plasma aldosterone decreased with individual treatments (valsartan, 11%-22%; nebivolol, 20%-26%), with the largest reduction (35%) observed with maximum combination dose (20 mg nebivolol/320 mg valsartan). Baseline ln(plasma renin activity) correlated with the 8-week reductions in 24-hour systolic and diastolic BP following treatments with the combination (all doses combined, P = .003 and P < .001) and nebivolol (both, P < .001), but not with valsartan. Baseline ln(aldosterone) correlated with 24-hour systolic and diastolic BP reductions following combination treatment only (P < .001 and P = .005). The implications of the renin-angiotensin-aldosterone system effects of this beta blocker-angiotensin receptor blocker combination should be explored further.
authors.affiliation: Department of Medicine, Tulane University, New Orleans, LA, USA. Electronic address: tgiles4@cox.net.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Giles
authors.affiliation: Department of Medicine, The University of Chicago, Chicago, IL, USA.
authors.forename: George
authors.initials: G
authors.lastname: Bakris
authors.affiliation: Division of Cardiovascular Disease, University of Alabama School of Medicine, Birmingham, AL, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.affiliation: Division of Cardiovascular Medicine, Downstate College of Medicine, State University of New York, Brooklyn, NY, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Weber
authors.affiliation: Department of Biostatistics, Forest Research Institute, Inc, an affiliate of Actavis, Inc (now: Allergan), Harborside Financial Center, Jersey City, NJ, USA.
authors.forename: Huiling
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Biostatistics, Forest Research Institute, Inc, an affiliate of Actavis, Inc (now: Allergan), Harborside Financial Center, Jersey City, NJ, USA.
authors.forename: Madhuja
authors.initials: M
authors.lastname: Mallick
authors.affiliation: Department of Clinical Development, Forest Research Institute, Inc, an affiliate of Actavis, Inc (now: Allergan), Harborside Financial Center, Jersey City, NJ, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Bharucha
authors.affiliation: Department of Clinical Development, Forest Research Institute, Inc, an affiliate of Actavis, Inc (now: Allergan), Harborside Financial Center, Jersey City, NJ, USA.
authors.forename: ChunLin
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Clinical Development, Forest Research Institute, Inc, an affiliate of Actavis, Inc (now: Allergan), Harborside Financial Center, Jersey City, NJ, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Ferguson
mesh_terms: D000450:Aldosterone / Q000097:blood; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D020714:Maximum Tolerated Dose; D000068577:Nebivolol / Q000008:administration & dosage*; D018579:Patient Selection; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D000068756:Valsartan / Q000008:administration & dosage*
chemical_list: D000068577:Nebivolol; D000450:Aldosterone; D000068756:Valsartan; D012083:Renin
keywords: ABPM; Vasodilatory beta-blocker; angiotensin II receptor blocker; biomarkers