Baseline serum calcium negatively correlated with blood pressure responses to amlodipine (P=0.001-0.002), and plasma renin activity positively correlated with responses to losartan (P=0.001-0.005).
RCT (n=208)
Double-blind
Randomized
Do baseline laboratory tests predict blood pressure responses to amlodipine, bisoprolol, hydrochlorothiazide, and losartan in men with moderate hypertension?
Baseline laboratory parameters such as serum calcium and plasma renin activity correlate with individual blood pressure responses to specific antihypertensive drug classes, suggesting potential value in predicting treatment efficacy.
OBJECTIVE: Individual blood pressure responses to antihypertensive therapy are difficult to predict. To improve optimization of antihypertensive therapy, we analyzed correlations of relevant laboratory tests with blood pressure responses to four antihypertensive monotherapies. METHODS: In the GENRES study, 208 Finnish men aged 35-60 years with moderate hypertension used amlodipine 5 mg, bisoprolol 5 mg, hydrochlorothiazide 25 mg and losartan 50 mg daily, each for 4 weeks as a monotherapy in a double-blind, randomized, placebo-controlled crossover study; that is, each subject received each type of monotherapy in a random order. The treatment periods were preceded and separated by 4-week placebo periods. Ambulatory 24-h and office blood pressure measurements were carried out after all study periods. Data from several biochemical tests were correlated to antihypertensive drug responses. RESULTS: Serum total calcium concentration was negatively correlated with blood pressure responses to amlodipine (P values 0.001-0.002). Plasma renin activity was positively correlated with blood pressure responses to losartan (P values 0.001-0.005) and bisoprolol (P values 0.03-0.17), and negatively with blood pressure responses to hydrochlorothiazide (P values 0.01-0.07). Daily urinary excretion of sodium was negatively correlated with ambulatory blood pressure responses to amlodipine (P values 0.001-0.01). CONCLUSIONS: In this carefully controlled study, marked individual variations in antihypertensive drug responsiveness were found to correlate to several baseline laboratory parameters. The negative correlation between serum calcium levels and amlodipine responses is intriguing and suggests an underlying mechanistic association. Collectively, our data imply that laboratory tests may have some value in prediction of the efficacy of various antihypertensive drug therapies, although great patient-to-patient variation remains an obstacle for exact predictive classification.
Suonsyrjä et al. (Sun,) conducted a rct in Moderate hypertension (n=208). Amlodipine, bisoprolol, hydrochlorothiazide, and losartan vs. Placebo was evaluated on Correlation of biochemical tests with antihypertensive drug responses. Baseline serum calcium negatively correlated with blood pressure responses to amlodipine (P=0.001-0.002), and plasma renin activity positively correlated with responses to losartan (P=0.001-0.005).