Daily Dose: Heterogeneity in BP Response to Antihypertensive Medications

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On April 14, 2023, we reported on a study published in JAMA that aimed to investigate and quantify the potential for targeting specific antihypertensive medications to specific persons to maximize blood pressure (BP) effects.

The study

A total of 280 adults with grade 1 hypertension (HTN) at low risk for cardiovascular events were scheduled for treatment in random order with agents from 4 different classes of BP-lowering drugs: lisinopril, candesartan, hydrochlorothiazide, and amlodipine. All participants received all 4 drugs and treatment periods were 7 to 9 weeks long. Following the initial 4 treatment periods, all participants repeated 2 of them, selected at random. In total there were 1468 treatment periods with a median length of 56 days. The mean age of participants was 64 years and 54.3% were men. Participants had HTN for a mean of 3 years and approximately 62% had previously used BP-lowering monotherapy. The primary outcome was ambulatory daytime systolic BP (SBP), measured at the end of each treatment period.

The findings

Results showed that the BP response to different treatments varied considerably between participants (P<.001), specifically for lisinopril vs hydrochlorothiazide, lisinopril vs amlodipine, candesartan vs hydrochlorothiazide, and candesartan vs amlodipine. Researchers excluded large differences for the choices of lisinopril vs candesartan and hydrochlorothiazide vs amlodipine.

Investigators observed that personalized treatment using single-drug therapy would on average lead to a 4.4 mm Hg-lower SBP than a fixed choice.

Note from authors

"This study provided evidence that widely used antihypertensive drugs vary in effectiveness between individuals, with potential for greater BP reductions with personalized targeting of therapy."

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