Getting the Right Hypertension Drug

Gautam Naik, Wall Street Journal, August 24, 2010

Roughly half the 50 million Americans who suffer from hypertension don’t succeed in keeping their blood pressure under control, often because they haven’t been prescribed the drug that would work best for them. Now, three new studies are suggesting ways to help make sure patients get the right medications.

Five types of drugs are commonly used for treating hypertension, or high blood pressure, a major risk factor for heart attacks and stroke. Doctors often choose among the drugs by trial and error, prescribing several of them in turn to see which works best for a particular patient. {snip}

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Doctors have known for decades that patients with different physical characteristics respond differently to various hypertension drugs. But little research has focused on matching specific pills to specific patients. The new studies, which appear in the latest issue of the American Journal of Hypertension, represent efforts to provide scientific guidance for doctors treating high blood pressure.

One of the studies, for example, shows that some drugs work better in certain ethnic groups than in others. Two other studies point to the importance of testing patients’ levels of renin, a hormone produced by the kidneys, as a guide in prescribing blood-pressure medicine. Researchers in each of the studies emphasized that larger-scale trials would be necessary before the findings could become part of official treatment guidelines.

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One of the studies, co-authored by Ajay Gupta of Imperial College London, looked at drug responses among 5,425 patients in various countries and across different ethnic groups. For example, in the U.K., south Asians are often given ace inhibitors as a first-line treatment, though the effectiveness of such prescriptions isn’t based on any hard evidence. Dr. Gupta’s study, for the first time, confirms that south Asians respond especially well to such drugs.

U.K. medical-treatment guidelines say that first-line drug therapies should be guided by a patient’s age and race. (Guidelines in the U.S. don’t include such suggestions.) Dr. Gupta and his colleagues showed that the same guidelines might also apply for second-line treatments. For example, if a black patient is given a calcium channel blocker or diuretic as the first drug, U.K. guidelines recommend adding an ace inhibitor.

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Nonetheless, one of the new studies, involving 363 patients, confirmed the 1970s finding, showing that measuring the renin level can be an effective method for selecting a blood-pressure medication. The research, by a team led by Stephen Turner of the Mayo Clinic in Rochester, Minn., found that a patient with a higher renin level probably should not be treated with a diuretic. The patient would probably respond better to a drug, such as a beta blocker, that functions differently in the body.

The predictive effects of renin activity “were statistically independent of race, age and other characteristics,” the team’s paper concludes. It found that renin levels could also serve as a guide for prescribing add-on therapies for some patients.

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