Predictors of blood pressure response to the angiotensin receptor blocker candesartan in essential hypertension
Predictors of blood pressure response to the angiotensin receptor blocker candesartan in essential hypertension
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DOI：
10.1038/ajh.2007.24
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发表时间：
2008-01-01
影响因子：
3.2
通讯作者：
Chapman, Arlene B.
中科院分区：
文献类型：
--
作者：
Canzanello, Vincent J.;Baranco-Pryor, Evelyn;Chapman, Arlene B.
背景：个体对抗高血压药物的反应差异很大。方法：我们研究了203名非裔美国人和236名非西班牙裔白人原发性高血压患者在至少4周（基线）的无药洗脱期后，接受坎地沙坦32mg /天治疗6周，这些患者可能预测血压（BP）反应的特征。在入组、基线和治疗结束时的测量被纳入线性回归模型，以量化它们对预测反应的附加贡献。结果预测更大反应的滚动测量是非西班牙裔白人，女性性别，种族和性别之间的相互作用，以及较低的体重。在基线测量中，较高的血压和较高的血浆肾素活性（PRA）对预测更大的反应有额外的贡献。在研究结束时进行的测量中，只有PRA较基线水平的较大增加有助于预测更大的反应。所有确定的预测因素的综合影响分别占收缩压和舒张压反应个体间差异的39%和33%（两者的P < 0.001）。结论：这些结果表明，易于确定的特征，如种族、性别、体重以及BP和PRA预处理水平，可以预测坎地沙坦对BP反应的很大一部分，并支持对利尿剂治疗反应较差的特征与对血管紧张素受体阻滞剂（ARB）反应较好的概念。
BACKGROUNDResponse to anti hypertensive drugs varies widely among individuals.METHODSWe studied characteristics that might be predictive of blood pressure (BP) response in 203 African-American and 236 non-Hispanic white subjects with essential hypertension treated with candesartan, 32 mg/day for 6 weeks, after a drug-free washout period of at least 4 weeks (baseline). Measurements at enrollment, baseline, and at the end of the treatment were incorporated into linear regression models to quantify their additive contributions to predicting response.RESULTSEnrollment measurements predictive of a greater response were non-Hispanic white ethnicity, female gender, the interaction between ethnicity and gender, and lower body weight. Of baseline measurements, higher BP and higher plasma renin activity (PRA) made additional contributions to predicting a greater response. Of the measurements made at the end of the study, only a larger increase in PRA from baseline contributed to predicting a greater response. The combined effects of all the identified predictors accounted for 39 and 33% of the interindividual variation in systolic and diastolic BP responses, respectively (P < 0.001 for both).CONCLUSIONSThese results indicate that easily determined characteristics such as ethnicity, gender, body weight, as well as pretreatment levels of BP and PRA predict a substantial fraction of the BP response to candesartan and support the notion that characteristics associated with a poor response to diuretic therapy are associated with better responses to an angiotensin receptor blocker (ARB).