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Role of renin secretion and kidney function in hypertension and attendant heart attack and stroke
1New York Hospital-Cornell University Medical College, NY 10021.
Insights
High blood pressure control alone doesn't prevent heart attacks. Targeting the renin system, which can cause damage, may reduce myocardial infarction risk in hypertensive patients.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Endocrinology
Background:
- Blood pressure control alone has limited impact on heart attack incidence in hypertensive patients.
- Myocardial infarction risk may be linked to specific mechanisms beyond general blood pressure.
- The renin-angiotensin system's role in cardiovascular and cerebrovascular health warrants investigation.
Purpose of the Study:
- To investigate the relationship between renin levels and myocardial infarction risk in hypertensive patients.
- To determine if renin status can predict heart attack incidence independently of other risk factors.
- To explore the potential of renin-targeted therapies for preventing heart attacks.
Main Methods:
- Prospective study involving 1,717 hypertensive patients.
- Analysis of plasma renin levels and their correlation with myocardial infarction.
- Assessment of renin as a continuous variable influencing heart attack risk.
Main Results:
- A significant positive relationship exists between high renin levels and myocardial infarction, irrespective of other risk factors.
- Heart attack risk increases with renin levels, showing a dose-dependent effect (low, medium, high).
- The renin-sodium profile may identify patients at risk for heart attacks, even without traditional risk factors.
Conclusions:
- Elevated renin production in hypertensive patients is abnormal and linked to increased myocardial infarction risk.
- Renin testing is recommended for hypertensive patients to assess prognosis and guide anti-renin therapy.
- The renin-sodium profile offers a valuable tool for risk stratification in hypertensive individuals.
Abstract:
Control of blood pressure usually has not, by itself, affected the incidence of heart attack in hypertensive patients. This suggests a need for cause-specific therapy targeted against mechanisms that engage the risks of myocardial infarction. Study of the renin system, the ongoing, long-term servo-control over blood pressure and electrolyte homeostasis may provide answers. Inappropriately high renin production, generating the powerful vasoconstrictor, angiotensin II, may cause ischemic vascular damage in the heart, kidney and brain, predisposing to infarction. Many clinical situations associated with high plasma renin levels are accompanied by striking vascular damage, heart attack, or stroke. A recent prospective study of 1,717 hypertensive patients shows an unequivocally positive relationship between myocardial infarction and high-renin status regardless of other risk factors such as smoking, hypercholesteremia, or diabetes. The data also suggest the possibility that renin is a continuous variable, since the risk of heart attack was significantly weaker in medium-renin than in high and significantly greater than in low renin subjects. These observations are in keeping with concept that any renin secretion in the face of arterial hypertension is abnormal, since the truly normal kidney completely turns off its renin secretion. Thus the renin-sodium profile appears to be especially useful for evaluating the large fraction of patients who develop heart attacks in the absence of these other risk factors. Although, these findings suggest that a renin test should be performed routinely in hypertensive patients, the better to assess prognosis and design appropriate anti-renin therapy.