title: Comparison of Blood Pressure Control Rates Among Recommended Drug Selection Strategies for Initial Therapy of Hypertension.
abstract: Several approaches to initiation of antihypertensive therapy have been suggested. These include thiazide diuretics (TDs) as the first drug in all patients, initial drug selection based on age and race criteria, or therapy selection based on measures of plasma renin activity (PRA). It is uncertain which of these strategies achieves the highest control rate with monotherapy in Stage-I hypertension. We sought to compare control rates among these strategies.
  
  
  
  We used data from the Pharmacogenomic Evaluation of Antihypertensive Responses study (PEAR) to estimate control rates for each strategy: (i) TD for all, (ii) age- and race-based strategy: Hydrochlorothiazide (HCTZ) for all blacks and for whites ≥50 years and a renin-angiotensin system inhibitor (atenolol) for whites <50 years) or (iii) a PRA based strategy: HCTZ for suppressed PRA (<0.6ng/ml/h) and atenolol for non-suppressed PRA (≥0.6ng/ml/h) despite age or race. Hypertension was confirmed prior to treatment with HCTZ (148 blacks and 218 whites) or with atenolol (146 blacks and 221 whites).
  
  
  
  In the overall sample, using clinic blood pressure (BP) response, the renin-based strategy was associated with the greatest control rate (48.9% vs. 40.8% with the age and race-based strategy (P = 0.0004) and 31.7% with the TD for all strategy (P < 0.0001)). The findings were similar using home or by 24-hour ambulatory BP responses and within each racial subgroup.
  
  
  
  A strategy for selection of initial antihypertensive drug therapy based on PRA was associated with greater BP control rates compared to a thiazide-for-all or an age and race-based strategy.
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA; kamelgharaibeh@yahoo.com.
authors.forename: Kamel A
authors.initials: KA
authors.lastname: Gharaibeh
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA;
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Turner
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA;
authors.forename: Abdurrahman M
authors.initials: AM
authors.lastname: Hamadah
authors.affiliation: Section of Nephrology, University of Chicago, Chicago, IL, USA;
authors.forename: Arlene B
authors.initials: AB
authors.lastname: Chapman
authors.affiliation: College of Pharmacy, University of Florida, Gainesville, FL, USA;
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Cooper-Dehoff
authors.affiliation: College of Pharmacy, University of Florida, Gainesville, FL, USA;
authors.forename: Julie A
authors.initials: JA
authors.lastname: Johnson
authors.affiliation: College of Pharmacy, University of Florida, Gainesville, FL, USA;
authors.forename: John G
authors.initials: JG
authors.lastname: Gums
authors.affiliation: Divisions of Biostatistics and Biomedical Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA;
authors.forename: Gary L
authors.initials: GL
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001262:Atenolol / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood*; D012189:Retrospective Studies; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000959:Antihypertensive Agents; D001262:Atenolol; D012083:Renin
keywords: antihypertensive drug therapy; atenolol; beta-blocker; blood pressure; hydrochlorothiazide; hypertension; plasma renin activity; thiazide diuretic.