| Objective: There are limited methods currently regarding selection of antihypertensive medication for lowering blood pressure (BP) of hypertensive patients. For such end, the renin test–guided therapeutic (RTGT) algorithm has been proposed and its efficacy in treated but uncontrolled hypertension has recently been demonstrated; however, it is not known whether the efficacy of the algorithm varies according to hypertension subtypes, namely, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and systolic–diastolic hypertension (SDH), which are commonly believed to reflect distinct pathophysiological mechanisms for elevated BP. Clarification of such remained issue, therefore, became the objective of the present study.Methods:387 patients who were treated in out hospital of the Hebei Medical University Second Hospital form October 2009 to February 2011, and whose symptoms were in line with diagnostic criteria for hypertension specified in 2005"Guidelines for Prevention and Treatment of hypertension in China"were chosen as the sample group. Hypertensive patients in whom antihypertensive medication has never been taken or had been taken but stopped for two weeks or more were classified as IDH, SDH or ISH and, at the same time, received antihypertensive medication(s) based on personal experience at the first (preliminary) visit. In the second (baseline) visit, excluded the patients whose systolic blood pressure (SBP) or/and diastolic blood pressure (DBP) had been controlled to goal levels, or had any changes leading to switching of the subtype. The remaining patients were followed by baseline examinations including measurement of PRA. Then they randomized into RTGT or senior general cardiologists'care (SGCC). Patients were scheduled every 2-3 weeks until BP was controlled or until the clinician determined that appropriate therapeutic adjustments had been made. RTGT protocol was in consistent with that originally proposed. The efficacy of RTGT focusing on changes of BP and antihypertensive medication number between the baseline and the last visit was compared to SGCC, and compared between the three subtypes of hypertension within RTGT group. 387 patients complete the study, 193 in RTGT (N=63 of IDH, N= 68 of SDH and N=62 of ISH) and 194 in senior general cardiologists'care (SGCC) (N=61 of IDH, N=70 of SDH and N=63 of ISH).Changes within the RTGT and CHSC groups from baseline to the last study visit were made using the Student's t-test for paired observations. Comparisons between the two groups at baseline, the last study visit, and differences between baseline and the last study visit were performed using the Student's two-samples t-test according to the prespecified analytical plan. All statistical analyses were performed using the SPSS13.0 program package. The date was expressed as mean±standard deviation. Chi-Square is used for the analysis of count date. A P value of less than 0.05 was considered to be statistically significant.Results: Compared with SGCC, the magnitude of decline in elevated components of BP was greater in RTGT in any hypertensive subtypes. DBP in IDH (-20.2±6.9 vs -17.5±6.2,P<0.05), both SBP (-37.9±12.8 vs -33.0±14.3,P<0.05) and DBP (-21.4±7.9 vs -17.4±8.2, P<0.05)in SDH, and SBP ( - 34.6±11.2和- 29.2±12.1, P < 0.05) in ISH.The antihypertensive drug number was comparably increased in RTGT and SGCC in the subtypes IDH(1.2±0.7 vs 1.3±0.6), SDH (1.2±0.9 vs 1.4±0.8), ISH (1.5±0.8 vs 1.4±0.7) (P>0.05 for all). Within RTGT group, there were no difference in magnitude of decline in DBP between IDH and SDH (-20.2±6.9 vs -21.4±7.9,P>0.05) or in SBP between ISH and SDH (-34.6±11.2 vs -37.9±12.8,P>0.05), and final antihypertensive medication number was no significant differences in any hypertensive subtypes,in IDH,ISH and SDH (1.2±0.7 vs 1.5±0.8 vs1.2±0.9, P>0.05).Conclusions: RTGT appears to be a logical antihypertensive strategy enabling greater decline in elevated SBP and/or DBP without increase or even reduction in antihypertensive medication number compared with SGCC in treated but uncontrolled hypertension irrespective of its original subtypes, and the efficacy of RTGT does not related to any specific hypertensive subtypes, sporting its universal applications in general population of treated but uncontrolled hypertension. |
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