The role of plasma renin activity, age, and race in selecting effective initial drug therapy for hypertension

Gary L. Schwartz, Kent Bailey, Arlene B. Chapman, Eric Boerwinkle, Stephen T. Turner

Research output: Contribution to journalArticle

19 Scopus citations


Background Strategies for initial drug therapy of hypertension are a thiazide diuretic for all or drug selection based on age/race criteria or on plasma renin activity (PRA). It is uncertain which of these strategies will achieve the highest control rate among patients with stage 1 essential hypertension. We sought to compare control rates among 3 drug selection strategies: (i) thiazide diuretic for all, (ii) thiazide diuretic for all black subjects and white subjects aged =50 years and a renin-angiotensin system blocker for white subjects aged >50 years, or (iii) thiazide diuretic for PRA > 0.6 ng/ml/h (suppressed PRA) and a renin-angiotensin system blocker for PRA = 0.6 ng/ml/h (nonsuppressed PRA). Methods Blood pressure responses from the Genetic Epidemiology of Responses to Antihypertensives (GERA) study were used to determine control rates for each of the 3 strategies. In GERA, hypertensive adults were treated with hydrochlorothiazide (n = 286 black subjects and 284 white subjects) or with candesartan (n = 248 black subjects and 278 white subjects). Results In the overall sample, the PRA strategy was associated with the highest control rate of 69.4% vs. 61.3% with the age/race strategy (P > 0.001) and 53.8% with the thiazide for all strategy (P > 0.001). This was also true in each racial subgroup (in black subjects: 62.1% vs. 55.2% for the other 2 strategies, P = 0.02; in white subjects: 76.3% vs. 67.1% with the age/race strategy (P > 0.001) and 52.4% with the thiazide for all strategy (P > 0.001)). Conclusions This exploratory analysis suggests that choice of initial therapy for hypertension using a PRA strategy may be associated with higher control rates than alternative strategies recommended in current guidelines.

Original languageEnglish (US)
Pages (from-to)957-964
Number of pages8
JournalAmerican journal of hypertension
Issue number8
StatePublished - Aug 1 2013



  • Blood pressure
  • Control rate
  • Hypertension
  • Pharmacotherapy

ASJC Scopus subject areas

  • Internal Medicine

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