Advertisement

Variability in Response to Antihypertensive Drugs

  • Barry J. Materson
    Correspondence
    Requests for reprints should be addressed to Barry J. Materson, MD, MBA, Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, OPPRP (D54), PO Box 016960, Miami, Florida 33101.
    Affiliations
    Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
    Search for articles by this author

      Abstract

      Heterogeneity of treatment effects (HTE) is a measure of the variations in individual treatment response to the same agent across a population. Hypertension affords an appropriate model for investigators of HTE. Use of blood pressure measurement guidelines and consistent techniques help to reduce the potential variability associated with clinician measurements. Patient characteristics such as age and race/ethnicity can affect blood pressure, including patient response and adverse events observed with antihypertensive medication. Through pharmacogenetic advances, potential underlying causes for such variation are emerging. The growing number of clinical examples of mutations that affect antihypertensive response includes multiple polymorphisms within the components of the renin-angiotensin-aldosterone system. The most prominent examples of these polymorphisms exist in the genes coding for angiotensinogen, angiotensin-converting enzyme, and the angiotensin II type 1 receptor. An understanding of the components of blood pressure variability and sources of HTE in antihypertensive therapy is important for analyzing published reports on this topic. It is also helpful when designing treatment protocols for individual patients with hypertension and in assessing their response to therapy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Greenfield S.
        • Kravitz R.
        • Duan N.
        • Kaplan S.H.
        Heterogeneity of treatment effects: implications for guidelines, payment and quality assessment.
        Am J Med. 2007; 120: S3-S9
        • Murphy W.B.
        The Healing Heart: An Illustrated History of Cardiology. Greenwich Press, Greenwich, CT1998
        • Riva-Rocci S.
        Un nuovo sfigmomanometro.
        Gazzeta Medica di Torino. 1896; 47 (1001–1017): 981-996
        • Riva-Rocci S.
        Tecnica sfigmomanometrica.
        Gazzeta Medica di Torino. 1897; 48 (181–191): 161-172
        • Riva-Rocci S.
        • Zanchetti A.
        • Mancia G.
        A new sphygmomanometer: sphygmomanometric technique.
        J Hypertens. 1996; 14: 1-12
        • Korotkov N.S.
        Concerning the methods of blood pressure measurement (from the clinic of S. P. Fedorov).
        Proceedings of the Emperor’s Military Medical Academy of St Petersburg. 1905; 11 ([in Russian]): 365-367
        • Korotkov N.S.
        Concerning the problem of the methods of blood pressure measurement.
        J Hypertens. 2005; 23: 5
        • Mancia G.
        • Zanchetti A.
        One hundred years of auscultatory blood pressure: commemorating N.
        J Hypertens. 2005; 23: 1-2
        • Shlyakhto E.
        • Conrady A.
        Korotkoff sounds: what do we know about its discovery?.
        J Hypertens. 2005; 23: 3-4
      1. US Department of Transportation, Federal Aviation Administration. Licenses and certificates, special issuance: hypertension [Federal Aviation Administration Web site]. Available at: http://www.faa.gov/licenses_certificates/medical_certification/specialissuance/hypertension/index.cfm. Accessed August 25, 2006.

        • Lewington S.
        • Clarke R.
        • Qizilbash N.
        • Peto R.
        • Collins R.
        Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
        Lancet. 2002; 360: 1903-1913
        • Kamel N.
        • Gursoy A.
        • Koseoglulari O.
        • Dincer I.
        • Gullu S.
        Isolated office hypertension: association with target organ damage and cardiovascular risk indices.
        J Natl Med Assoc. 2006; 98: 601-606
        • Ayman D.
        The diastolic blood pressure: its variability.
        Arch Intern Med. 1931; 48: 89-97
        • Pickering G.W.
        High Blood Pressure. 2nd ed. Grune & Stratton, New York1968
        • Modesti P.A.
        • Morabito M.
        • Bertolozzi I.
        • et al.
        Weather-related changes in 24-hour blood pressure profile: effects of age and implications for hypertension management.
        Hypertension. 2006; 47: 155-161
        • Jones H.
        • Atkinson G.
        • Leary A.
        • et al.
        Reactivity of ambulatory blood pressure to physical activity varies with time of day.
        Hypertension. 2006; 47: 778-784
        • Pickering T.G.
        • Hall J.E.
        • Appel L.J.
        • et al.
        Recommendations for blood pressure measurement in humans: an AHA scientific statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee.
        J Clin Hypertens (Greenwich). 2005; 7: 102-109
        • O’Brien E.
        • Mee F.
        • Atkins N.
        • O’Malley K.
        Inaccuracy of seven popular sphygmomanometers for home measurement of blood pressure.
        J Hypertens. 1990; 8: 621-634
        • Hamilton M.
        • Pickering G.W.
        • Roberts J.A.
        • Sowry G.S.
        The aetiology of essential hypertension. II.
        Clin Sci (Lond). 1954; 13: 37-49
        • Rose G.A.
        • Holland W.W.
        • Crowley E.A.
        A sphygmomanometer for epidemiologists.
        Lancet. 1964; 13: 296-300
        • Kimura A.
        • Hashimoto J.
        • Watabe D.
        • et al.
        Patient characteristics and factors associated with inter-arm difference of blood pressure measurements in a general population in Ohasama, Japan.
        J Hypertens. 2004; 22: 2277-2283
        • Houweling S.T.
        • Kleefstra N.
        • Lutgers H.L.
        • et al.
        Pitfalls in blood pressure measurement in daily practice.
        Fam Pract. 2006; 23: 20-27
        • Freis E.D.
        • Veterans Administration Cooperative Study Group on Antihypertensive Agents
        Effects of treatment on morbidity in hypertension: results in patients with diastolic blood pressures averaging 115 through 129 mm Hg.
        JAMA. 1967; 202: 1028-1034
        • Veterans Administration Cooperative Study Group on Antihypertensive Agents
        Comparison of propranolol and hydrochlorothiazide for the initial treatment of hypertension. I.
        JAMA. 1982; 248: 1996-2003
        • Veterans Administration Cooperative Study Group on Antihypertensive Agents
        Efficacy of nadolol alone and combined with bendroflumethiazide and hydralazine for systemic hypertension.
        Am J Cardiol. 1983; 52: 1230-1237
        • Veterans Affairs Cooperative Study Group on Antihypertensive Agents
        Racial differences in response to low-dose captopril are abolished by the addition of hydrochlorothiazide.
        Br J Clin Pharmacol. 1982; 14: 97S-101S
        • Mokwe E.
        • Ohmit S.E.
        • Nasser S.A.
        • et al.
        Determinants of blood pressure response to quinapril in black and white hypertensive patients: the Quinapril Titration Interval Management Evaluation trial.
        Hypertension. 2004; 43: 1202-1207
        • Materson B.J.
        • Reda D.J.
        • Cushman W.C.
        • et al.
        • Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents
        Single-drug therapy for hypertension in men: a comparison of six antihypertensive agents with placebo.
        N Engl J Med. 1993; 328: 914-921
        • Materson B.J.
        • Reda D.J.
        • Cushman W.C.
        • Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents
        Department of Veterans Affairs single-drug therapy of hypertension study: revised figures and new data.
        Am J Hypertens. 1995; 8: 189-192
        • Preston R.A.
        • Materson B.J.
        • Reda D.J.
        • et al.
        • Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents
        Age-race subgroup compared with renin profile as predictors of blood pressure response to antihypertensive therapy.
        JAMA. 1998; 280: 1168-1172
        • McDowell S.E.
        • Coleman J.J.
        • Ferner R.E.
        Systematic review and meta-analysis of ethnic differences in risks of adverse reactions to drugs used in cardiovascular medicine.
        BMJ. 2006; 332: 1177-1181
        • Materson B.J.
        • Reda D.
        • Freis E.D.
        • Henderson W.G.
        Cigarette smoking interferes with treatment of hypertension.
        Arch Intern Med. 1988; 148: 2116-2119
        • Lee B.L.
        • Benowitz N.L.
        • Jacob III, P.
        Cigarette abstinence, nicotine gum, and theophylline disposition.
        Ann Intern Med. 1987; 106: 553-555
        • Sciarrone M.T.
        • Stella P.
        • Barlassina C.
        • et al.
        ACE and α-adducin polymorphism as markers of individual response to diuretic therapy.
        Hypertension. 2003; 41: 398-403
        • Safar M.E.
        • Benetos A.
        Factors influencing arterial stiffness in systolic hypertension in the elderly: role of sodium and the renin-angiotensin system.
        Am J Hypertens. 2003; 16: 249-258