Heterogeneity in BP-Lowering Effects of 4 Drugs

A Swedish randomized, double-blind, repeated crossover trial revealed substantial heterogeneity in blood pressure (BP) response to drug therapy for high BP. There were 280 participants with grade 1 high BP at low risk for cardiovascular events (54% men; mean age, 64 years). Each participant was randomized to treatment with 4 different classes of BP–lowering drugs. A total of 1468 completed treatment periods (median length, 56 days) were recorded in 270 of the participants. The BP response to different treatments varied considerably between individuals, specifically for the choices of lisinopril vs hydrochlorothiazide, lisinopril vs amlodipine, candesartan vs hydrochlorothiazide, and candesartan vs amlodipine. There were no large differences for the choices of lisinopril vs candesartan and hydrochlorothiazide vs amlodipine. Personalized treatment had the potential to provide an additional 4.4 mmHg–lower systolic BP, a magnitude twice that achieved by doubling the dose of a first BP-lowering drug, and more than half that of adding a second drug on average. The findings highlight the need for greater BP reductions with personalized targeting of therapy. Differences due to normal within person variation in BP are generally much larger than the differences achieved by titrating a BP-lowering drug. Source: https://jamanetwork.com/