Antihypertensive Drugs Tied to Pressor Responses

Occur most commonly in those with low renin levels given β-blockers and ACE inhibitors

MONDAY, Aug. 23 (HealthDay News) -- Commonly used antihypertensive drugs cause pressor responses fairly frequently, particularly in patients with low renin levels who receive β-blockers or angiotensin-converting enzyme (ACE) inhibitors, according to a study published online Aug. 19 in the American Journal of Hypertension.

Michael H. Alderman, M.D., of the Albert Einstein College of Medicine in Bronx, N.Y., and colleagues evaluated systolic blood pressure (SBP) responses in 945 individuals without prior treatment who participated in a worksite-based antihypertensive treatment program from 1981 to 1998. Participants were administered a diuretic or calcium-channel blocker (V drugs) or a β-blocker or ACE inhibitor (R drugs).

The researchers found that more pressor responses occurred with R drugs than with V drugs (11 versus 5 percent). In patients given V drugs, those in all three renin tertiles had similar pressor frequencies, but among those given R drugs, those in the low and middle tertiles had greater frequencies (17 and 10 percent versus V, respectively) of a pressor response. In addition, treatment SBP of ≥160 mm Hg occurred more commonly with R drugs compared to V drugs (19 versus 13 percent). Among the lowest renin tertile, SBP of ≥160 mm Hg was more common with R drugs than with V drugs (35 versus 13 percent). Treatment SBP of <130 mm Hg was more common for patients who were in the lowest renin tertile and taking V drugs (18 versus 5 percent) and for patients in the highest tertile taking R drugs (26 versus 12 percent).

"In sum, pressor responses to antihypertensive drug monotherapy appear to be neither rare nor the result of chance alone. Also, our data indicate that patients with low plasma renin activity values are at the highest risk of a pressor response when prescribed an R drug. Furthermore, it is important to recognize that ≥10 mm Hg increases in systolic pressure can occur with any antihypertensive drug, and at any level of plasma renin activity," the authors write.

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