Initiation of antirenin drugs (beta-blockers or ACE inhibitors) caused more pressor responses (SBP rise ≥10 mm Hg) compared to antivolume drugs (11% vs. 5%, P=0.001).
Observational (n=945)
Does initiation of antirenin drugs compared to antivolume drugs increase the incidence of pressor responses in previously untreated hypertensive patients?
Initiation of beta-blockers or ACE inhibitors in previously untreated hypertensive patients, particularly those with low plasma renin activity, is associated with a higher incidence of paradoxical pressor responses compared to diuretics or calcium-channel blockers.
Absolute Event Rate: 11% vs 5%
p-value: p=0.001
BACKGROUND: Pressor responses to antihypertensive drugs are not addressed in treatment guidelines although they have been described in various clinical situations. We now report the incidence of pressor responses to initiation of monotherapy using four antihypertensive drug types, and the influence of plasma renin activity (PRA) status, among participants in a worksite-based antihypertensive treatment program. METHODS: Systolic blood pressure (SBP) response was evaluated among 945 participants with no prior treatment who were given either a diuretic or calcium-channel blocker (natriuretic antivolume V drugs, n = 537) or a beta-blocker or angiotensin-converting enzyme (ACE) inhibitor (antirenin R drugs n = 408). PRA was categorized by low, middle, and high tertiles (L, M, and H). SBP rise > or =10 mm Hg was considered pressor. RESULTS: More pressor responses occurred with R than V drugs (11% vs. 5%, P = 0.001). L, M, and H renin tertiles had similar frequencies with V drugs (6, 4, and 6%), but low and middle tertiles given R had greater pressor frequencies (17% P = 0.003 vs. V and 10% P = 0.02 vs. V). Treatment SBP > or =160 mm Hg occurred more frequently with R than V drugs (19% vs. 13%; P = 0.007); moreover, in the lowest renin tertile 35% R vs. 13% V (P = 0.001) had SBP > or =160 mm Hg. Treatment SBP <130 mm Hg was more frequent in V patients in the lowest tertile (18% vs. 5%; P = 0.003), and in R patients in the highest tertile (26% vs. 12%, P = 0.002). CONCLUSIONS: Pressor responses to antihypertensive monotherapy occur sufficiently frequently to be of concern, especially in lower renin patients given a beta-blocker or ACE inhibitor (ACEI).
Alderman et al. (Thu,) conducted a observational in Hypertension (n=945). Antirenin R drugs (beta-blocker or ACE inhibitor) vs. Natriuretic antivolume V drugs (diuretic or calcium-channel blocker) was evaluated on Pressor response (SBP rise ≥10 mm Hg) (p=0.001). Initiation of antirenin drugs (beta-blockers or ACE inhibitors) caused more pressor responses (SBP rise ≥10 mm Hg) compared to antivolume drugs (11% vs. 5%, P=0.001).