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Renin profile, race, and antihypertensive efficacy with atenolol and labetalol
J T Wright1, D J DiPette, R P Goodman
1Department of Medicine, Medical College of Virginia, Commonwealth University, Richmond.
Insights
This study found that both labetalol and atenolol were less effective in lowering blood pressure for Black patients compared to White patients with essential hypertension. Atenolol
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Essential hypertension affects diverse populations differently.
- Labetalol and atenolol are common antihypertensive medications.
- Renin profiles may influence drug response.
Purpose of the Study:
- To compare the efficacy of labetalol and atenolol in Black and White patients with essential hypertension.
- To investigate the role of pretreatment renin levels in antihypertensive response.
Main Methods:
- Randomized, double-blind, parallel-group study.
- Inclusion of Black and White patients with uncomplicated essential hypertension.
- Dosage titration of labetalol (100-800 mg BID) and atenolol (50-100 mg QD) to achieve target diastolic BP.
Main Results:
- Both labetalol and atenolol demonstrated reduced efficacy in Black patients compared to White patients.
- Atenolol showed supine blood pressure reductions of -18/-14 mmHg in Whites vs. -6/-6 mmHg in Blacks.
- Labetalol showed supine blood pressure reductions of -13/-12 mmHg in Whites vs. -2/-7 mmHg in Blacks.
- Standing blood pressure reductions with atenolol: -19/-14 mmHg (Whites) vs. -4/-5 mmHg (Blacks).
- Standing blood pressure reductions with labetalol: -17/-17 mmHg (Whites) vs. -19/-9 mmHg (Blacks).
- Atenolol's blood pressure response positively correlated with pretreatment renin values, unlike labetalol.
Conclusions:
- Neither labetalol nor atenolol achieved optimal blood pressure control in Black hypertensives compared to White hypertensives.
- Pretreatment renin levels may predict atenolol response in essential hypertension.
- Further research is needed to optimize antihypertensive strategies for diverse populations.
Abstract:
In this randomised double-blind parallel study, we compared the efficacy of labetalol and atenolol in a group of black (n = 33) and white (n = 34) hypertensives with uncomplicated essential hypertension after obtaining pretreatment renin profiles. After single-blind placebo (14-21 days), patients with standing diastolic BP between 105-119 mmHg were randomised to receive either labetalol (100-800 mg twice daily) or atenolol (50-100 mg once daily) to achieve a DBP less than 90 mmHg. Dosage titration occurred at weekly intervals for labetalol and biweekly for atenolol. The supine BP decrease with atenolol was -18/-14 vs. -6/-6 mmHg in whites vs. blacks respectively. With labetalol, it was -13/-12 in whites and -2/-7 mmHg in blacks. Standing BPs were: -19/-14 vs. -4/-5, whites vs. blacks with atenolol and -17/-17 vs. -19/-9 mmHg with labetalol. Neither labetalol nor atenolol was as effective in black compared with white hypertensives. The atenolol but not labetalol BP response was positively correlated with pretreatment renin values.