Influence of diabetes and type of hypertension on response to antihypertensive treatment

The aim of our investigation was to determine whether the presence of addit ional risk factors or type of hypertension (diastolic or isolated systolic) influences blood pressure (BP) response to treatment. The International Ni fedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSI GHT) study is a double-blinded outcome comparison of calcium channel blocka de with diuretics in high-risk patients aged 55 to 80 years. Dynamic random ization between nifedipine once daily and hydrochlorothiazide/amiloride was performed to ensure that approximately equal numbers of patients in the 2 groups had each of the major cardiovascular risk factors. Patients with iso lated systolic hypertension were also separately randomized. Atenolol or en alapril was the mandatory second-line drug. In 5669 patients who completed the Is-week titration, BP fell from 172+/-15/99+/-9 mm Pig (mean+/-SD) whil e receiving placebo to 139+/-12/82+/-7 mm Hg. Twenty-six percent of patient s required 2 drugs, and 4% required 3 drugs. Patients with diabetes were th e most resistant to treatment, requiring second and third drugs 40% and 100 % more frequently than patients without diabetes and achieving marginally t he highest final BP, for any risk group, of 141+/-13/82+/-8 mm Hg. Age, smo king, gender, hypercholesterolemia, left ventricular hypertrophy, and exist ing atherosclerosis had little (<1 mm Hg) or no influence on BP at the end of titration, but all except smoking slightly reduced the initial response of either systolic or diastolic BP. Patients with isolated systolic hyperte nsion were slightly more responsive than average to treatment. Our findings suggest that in patients at high absolute risk of cardiovascular complicat ions from hypertension, the risk factors themselves do not prevent the reco mmended BP targets from being achieved.