Patient characteristics do not predict the individual response to antihypertensive medication: a cross-over trial
Mark C van der Wel1, Marion Biermans1, Reinier Akkermans1
1Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Insights
Predicting hypertension treatment response is challenging. This study found no patient characteristics reliably predict how individuals respond to hydrochlorothiazide or valsartan in primary care settings.
Area of Science:
- Cardiology
- Pharmacology
- Primary Care Medicine
Background:
- International hypertension guidelines offer conflicting advice on using patient characteristics for initial treatment selection in uncomplicated essential hypertension.
- Essential hypertension management lacks consensus on personalized treatment strategies.
Purpose of the Study:
- To identify patient characteristics that predict treatment response to two distinct antihypertensive drug classes in newly diagnosed hypertension patients within a primary care setting.
- Investigate predictors for hydrochlorothiazide versus valsartan efficacy in essential hypertension.
Main Methods:
- A prospective, randomized, open-label, blinded-endpoint crossover trial involving 120 newly diagnosed hypertension patients from 10 family practices.
- Patients received sequential 4-week treatments of hydrochlorothiazide (12.5 mg/day) and valsartan (80 mg/day), separated by a 4-week washout period.
- Key patient data and 24-hour ambulatory blood pressure were monitored to determine the primary outcome: difference in systolic blood pressure response between the two drugs.
Main Results:
- Out of 120 patients, 98 (52% female, median age 53) completed the per-protocol analysis.
- No investigated patient characteristics (e.g., age, sex, plasma renin, NT-proBNP, eGFR) were found to predict the difference in systolic blood pressure response between hydrochlorothiazide and valsartan.
- Individual systolic blood pressure responses varied widely, from an 18 mmHg increase to a 39 mmHg decrease.
Conclusions:
- This study could not identify reliable predictors of antihypertensive treatment response in primary care patients with newly diagnosed essential hypertension.
- The findings support guidelines (e.g., US, European) that do not prioritize patient characteristics for initial hypertension drug selection over guidelines (e.g., UK, Dutch) that may consider them.
Background:
International guidelines on hypertension management do not agree on whether patient characteristics can be used for the first choice of treatment of uncomplicated essential hypertension.
Objective:
We wanted to identify predictive patient characteristics to the response of two different classes of antihypertensive drugs in patients with newly diagnosed hypertension in primary care.
Methods:
We conducted a prospective, open label, blinded endpoint cross-over trial in 120 patients with a new diagnosis of hypertension from 10 family practices. Patients received 4 weeks of 12.5 mgr hydrochlorothiazide once daily and 4 weeks of 80 mgr valsartan once daily, each followed by a 4-week washout. The sequence of drugs was randomized. Age, sex and menopausal state were recorded at run in and 24 h ambulatory blood pressure, office blood pressure, plasma renin concentration, NT-proBNP, potassium, estimated glomerular filtration rate, urinary albumin, body mass index and waist circumference at each regimen change. The difference in systolic blood pressure response between both study drugs, calculated from mean daytime ambulatory blood pressures, was the main outcome measure.
Results:
Ninety-eight patients (52% female; median age 53 years) were eligible for per-protocol-analysis. None of the studied variables were predictive for the difference in systolic blood pressure response. Individual systolic blood pressure responses ranged from an increase by 18 mmHg to a decrease of 39 mmHg.
Conclusion:
In a relevant group of primary care patients with newly diagnosed hypertension, we were unable to detect predictors of treatment response. This study rather supports the United States and European guidelines than the United Kingdom and Dutch guidelines on hypertension.
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