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(Hypertension. 2006;47:e11.)
© 2006 American Heart Association, Inc.

Letters to the Editor

Letter to the Editor

Individualized Therapy for Hypertension

Stroke Prevention & Atherosclerosis Research Centre, London, Ontario, Canada

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

The recent publication of the Blood Pressure Lowering Arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-BPLA) has again occasioned a flurry of media pronouncements and editorials contending that now the truth is known and that "newer" therapies are more effective than "old" therapies for hypertension—ß-blockers and diuretics. A similar flurry of media pronouncements, but in the opposite direction, was trumpeted after the publication of the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT), which showed that diuretics were "the best" therapy for hypertension. Largely unnoticed amid all this fuss was the second Australian National Blood Pressure study (ANBP2), which followed closely on the heels of the ALLHAT trial, and, like ASCOT-BPLA, also showed that angiotensin-converting enzyme inhibitors were better than diuretics. So what are these trials trying to tell us?

The fundamental fallacy underlying all this nonsense is the assumption that all patients are the same and therefore that there exists a single "best therapy" for all hypertensive patients. We should know better.

It has been clear for many years that patients with African ancestors, on average, had lower levels of plasma renin than did patients without African ancestors and that patients with African ancestors responded better to diuretics.¹ It has also been clear for many years that measuring plasma renin is very helpful in the management of resistant hypertension. As pointed out by the authors of ANBP2, "In ALLHAT, 32% of the patients were non-Hispanic blacks, 16% were Hispanics, and 47% were non-Hispanic whites, whereas in . . . [Full Text of this Article]