Renin-angiotensin-aldosterone System Polymorphisms in Resistant Hypertension and Adverse Cardiovascular Events
Condition: Systemic Arterial Hypertension; Hypertension Resistant to Conventional Therapy; Myocardial Infarction; Stroke
MeSH terms: Hypertension; Myocardial Infarction; Coronary Vasospasm; Infarction
Study type: Observational

Summary: 
      Renin-angiotensin-aldosterone system (RAAS) polymorphisms influence 24h arterial pressure
      fluctuation. Resistant systemic arterial hypertension (RSAH) has an increased risk of end
      organ damage and unfavourable prognosis, whereas pseudo-RSAH usually respond favourably to
      drug therapy.

      To prospectively investigate, in subjects with RSAH in a tropical South American city: 1)
      Adverse cardiovascular events defined as fatal and non-fatal stroke or acute myocardial
      infarction (AMI); and 2) the association of RAAS polymorphisms and adverse cardiovascular
      events in this population.

      Study population: 212 hypertensives recruited from primary care assistance (time since first
      diagnosis of hypertension: 16.5±8.1 years) and without appropriate pressure control, between
      2001 and 2006, corresponding to 0.48% of all hypertensives under care (18 new cases/year),
      57±10 years old, 66% females. Under drug treatment schedule: three or more drugs including a
      diuretic. Ninety two randomly selected hypertensives basis had renin-angiotensin-aldosterone
      system genetic profile determined. Genetic assessment was carried out using a polymerase
      chain reaction assay amplification technique. The following single nucleotide polymorphisms
      were analyzed: renin (G1051A), angiotensinogen (M235T), angiotensin converting enzyme-ACE
      (I/D), angiotensin II type 1 receptor (A1166C), aldosterone synthase (C344T) and
      mineralocorticoid receptor (G3514C).
    


Intervention name(s): Anti-hypertensive drug treatment
Intervention type(s): Drug
Intervention description(s): Anti-hypertensive drug treatment was non-investigational. Drug regimen, including which drug and the number of drugs prescribed, was left at discretion of the physician who carried primary assistance.
Other intervention name(s): Thiazide Diuretics; Aldosterone receptor antagonist; Beta-blockers; ACE inhibitors; Angiotensin receptor blockers; Calcium channel blockers
Intervention MeSH terms: Antihypertensive Agents; Calcium Channel Blockers; Diuretics; Angiotensin-Converting Enzyme Inhibitors; Angiotensin Receptor Antagonists; Sodium Chloride Symporter Inhibitors; Mineralocorticoid Receptor Antagonists
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Subjects of both genders in investigation for resistant systemic arterial hypertension at
        the Hypertension Unit, whose arterial pressure control was not achieved by primary care
        assistance despite regular use of three anti-hypertensive drugs, including one diuretic.
        All subjects received standard drug therapy, aiming at achieving outpatients clinics
        pressure <140/90mmHg and were re-evaluated up to four weeks later, including 24h ambulatory
        arterial pressure monitoring.
      
Keywords: Systemic arterial hypertension; Hypertension Resistant to Conventional Therapy; Genetic polymorphisms; Renin-angiotensin-aldosterone system genetic polymorphism; Risk markers; Adverse events; Acute myocardial infarction; Stroke