| Objective:To investigate BMI-related differences in blood pressure response to single antihypertensive drug in a community-based, double-blind, active-controlled, randomized prospective clinical trail.Methods:The study was conducted in 7 rural communities in Henan, China.3535 untreated hypertensive patients, aged 40-75 years, were recruited. Subjects were randomized to 1 of 4 drug groups:hydrochlorothiazide (HCTZ), atenolol, nifedipine, and captopril. Duration of the study was 8 weeks. Patients in each treatment group were stratified into 4 categories of BMI:thin, normal weight, overweight, and obesity. Blood pressure response and blood pressure control rate were compared among normal weight, overweight, and obesity groups.Results:In HCTZ, atenolol, or captopril treatment group, obesity predicted increased uncontrolled systolic blood pressure (adjusted OR,1.866,95%CI:1.084-3.213, p<0.05; OR,2.393,95%CI:1.262-4.541;P<0.01; OR,1.817,95%CI:1.130-2.921, p<0.05; respectively). And also in those 3 single-drug groups, adjusted means of SBP reductions were significant lower through obese hypertensive to non-obese hypertensive. No significant BMI-related difference in blood pressure response to nifedipine was found.Conclusions:The study demonstrates that HCTZ, atenolol, and captopril are less effective in hypertensives with obesity than with normal weight when used as monotherapy. But the same effect was not found on BP response to nifidepine. These data may help to develop the guidelines for obesity-associated hypertension. Whether BMI-related differences in long-term outcomes of 4 single antihypertensive drugs would exist, is unknown, and would require further study. Objective:Previously, some case-control studies suggested that the insertion/deletion (I/D) single nucleotide polymorphism of Angiotensin converting enzyme (ACE) gene was associated with ACE inhibitors-related cough. However, other studies did not confirm this relationship. The present study was to assess the relationship between ACE I/D polymorphism and ACEI-related cough by using a meta-analysis.Methods:Databases, including PubMed, EMbase, Cochrane Library database and China National Knowledge Infrastructure (CNKI), were searched to get the genetic association studies. Data were extracted by two independent authors and pooled OR with 95% CI was calculated. Meta-regression and subgroup analyses were performed to identify the source of heterogeneity.Results:A total of 11 trails including 906 cases (ACEI-related cough) and 1,175 controls were reviewed in the present meta-analysis. The random effects (RE) pooled OR was 1.16 (95% CI:0.78,1:74; p=0.46) in dominant model, and was 1.61(95% CI: 1.18,2.20; p=0.003) in recessive model. Heterogeneity among studies was found. Meta-regression indicated that the effect size was positively related to age and negatively related to fellow-up duration of ACEIs treatment. Subgroup analysis showed that significant association of ACE I/D polymorphism with ACEI-related cough existed in the elderly (age>60 years), but no association in studies with mean age less than 60 years. No heterogeneity was found in each mean age subgroups. We also found no association of ACE I/D polymorphism and ACEI-related cough in studies with fellow-up duration longer than 2 months and in Caucasian studies. No heterogeneity was detected in those two subgroups.Conclusion:The synthesis of available evidence supports that ACE I/D polymorphism is an age-dependent predictor for the risk of ACEI-related cough. |
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