WASHINGTON -- It's hard to predict which pills will best lower which patient's high blood pressure, but researchers are hunting ways to better personalize therapy -- perhaps even using a blood test.
The work is controversial, challenging today's usual approach to treating the hypertension that plagues nearly one in three U.S. adults.
Now a three studies show some drug combinations work better for certain populations -- and raises the possibility that measuring blood levels of a hormone involved in hypertension might help optimize some people's care.
Don't expect a routine test for that hormone, called renin, any time soon. Many doctors are skeptical because initial research a few decades ago failed to show a clear benefit, says Dr. Ernesto Schiffrin of Canada's McGill University, a hypertension specialist with the American Heart Association.
"The reality is that trial and error is to some degree what has to be done because patients are different and some patients develop adverse effects with one agent and others don't," he said.
But with blood testing now easier and more reliable, some experts say it's time for broader studies to settle the debate.
"We must redirect our efforts away from the strategy of treating hypertension as one condition," wrote Wake Forest University public health specialist Dr. Curt Furberg. He pushed renin-guided therapy in an editorial accompanying the new research in this month's American Journal of Hypertension.
Among the new findings:
--In a study of 954 people prescribed a single drug, those with low renin levels responded best to a diuretic. But people with high renin levels responded better to such medicines as ACE inhibitors that target an artery-narrowing substance spurred by the renin, Alderman said.
--Nearly 8 percent of patients had their blood pressure jump at least 10 points after starting medication, Alderman found. Most at risk were people who had low renin levels yet were prescribed anti-renin drugs such as ACE inhibitors or beta blockers.
