STUDY OBJECTIVES: To determine the correlation between ambulatory and clinic blood pressure in assessing antihypertensive response to beta-blockade, to test whether blood pressure response to metoprolol is associated with the heart rate response, and to determine whether exercise and resting heart rate responses to metoprolol are correlated. DESIGN: Post hoc analysis of a prospective cohort study. SETTING: University-affiliated general clinical research center. PATIENTS: Fifty-one patients aged 35-65 years with uncomplicated hypertension. Intervention. All patients received metoprolol at a dosage titrated to achieve a diastolic blood pressure below 90 mm Hg. MEASUREMENTS AND MAIN RESULTS: Clinic and 24-hour ambulatory blood pressure measurements were obtained and exercise treadmill testing was performed before and after metoprolol treatment. Based on ambulatory blood pressure data, 24 patients (47%) responded (defined as at least a 10% reduction in diastolic blood pressure) to metoprolol compared with 36 patients (71%) based on clinic blood pressure data (p=0.027). Clinic blood pressure was associated with a 67% false-positive rate (responsive blood pressure by clinic data that was actually nonresponsive by ambulatory data). Blood pressure responders and nonresponders exhibited similar reductions in exercise heart rate (24% and 23%, p=0.74). However, responses to metoprolol measured by exercise heart rate versus resting heart rate were not significantly correlated (r=0.24, p=0.105). CONCLUSION: Reliance on clinic blood pressure or resting heart rate for making beta-blocker treatment decisions may yield less than optimal assessment of the antihypertensive response or degree of beta-blockade.
STUDY OBJECTIVES: To determine the correlation between ambulatory and clinic blood pressure in assessing antihypertensive response to beta-blockade, to test whether blood pressure response to metoprolol is associated with the heart rate response, and to determine whether exercise and resting heart rate responses to metoprolol are correlated. DESIGN: Post hoc analysis of a prospective cohort study. SETTING: University-affiliated general clinical research center. PATIENTS: Fifty-one patients aged 35-65 years with uncomplicated hypertension. Intervention. All patients received metoprolol at a dosage titrated to achieve a diastolic blood pressure below 90 mm Hg. MEASUREMENTS AND MAIN RESULTS: Clinic and 24-hour ambulatory blood pressure measurements were obtained and exercise treadmill testing was performed before and after metoprolol treatment. Based on ambulatory blood pressure data, 24 patients (47%) responded (defined as at least a 10% reduction in diastolic blood pressure) to metoprolol compared with 36 patients (71%) based on clinic blood pressure data (p=0.027). Clinic blood pressure was associated with a 67% false-positive rate (responsive blood pressure by clinic data that was actually nonresponsive by ambulatory data). Blood pressure responders and nonresponders exhibited similar reductions in exercise heart rate (24% and 23%, p=0.74). However, responses to metoprolol measured by exercise heart rate versus resting heart rate were not significantly correlated (r=0.24, p=0.105). CONCLUSION: Reliance on clinic blood pressure or resting heart rate for making beta-blocker treatment decisions may yield less than optimal assessment of the antihypertensive response or degree of beta-blockade.
Authors: K M Giacomini; C M Brett; R B Altman; N L Benowitz; M E Dolan; D A Flockhart; J A Johnson; D F Hayes; T Klein; R M Krauss; D L Kroetz; H L McLeod; A T Nguyen; M J Ratain; M V Relling; V Reus; D M Roden; C A Schaefer; A R Shuldiner; T Skaar; K Tantisira; R F Tyndale; L Wang; R M Weinshilboum; S T Weiss; I Zineh Journal: Clin Pharmacol Ther Date: 2007-03 Impact factor: 6.875
Authors: Julie A Johnson; Eric Boerwinkle; Issam Zineh; Arlene B Chapman; Kent Bailey; Rhonda M Cooper-DeHoff; John Gums; R Whit Curry; Yan Gong; Amber L Beitelshees; Gary Schwartz; Stephen T Turner Journal: Am Heart J Date: 2009-03 Impact factor: 4.749
Authors: Amber L Beitelshees; Yan Gong; Kent R Bailey; Stephen T Turner; Arlene B Chapman; Gary L Schwartz; John G Gums; Eric Boerwinkle; Julie A Johnson Journal: J Clin Hypertens (Greenwich) Date: 2010-01 Impact factor: 3.738