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High renin hypertension in the elderly
Insights
Elderly patients with high renin hypertension often show rapid blood pressure acceleration and are more likely to have renovascular hypertension. This suggests a link between high renin levels and specific clinical markers in older adults.
Area of Science:
- Nephrology
- Geriatrics
- Cardiology
Background:
- Hypertension is a common condition in the elderly.
- High renin activity is a less understood subtype of hypertension, particularly in older populations.
Purpose of the Study:
- To describe the clinical features of high renin hypertension in elderly patients.
- To investigate the association between high renin activity and specific clinical manifestations and potential underlying causes like renovascular hypertension.
Main Methods:
- Study included 59 hypertensive patients aged 70-86.
- Patients were divided into high renin (PRA ≥ 3.0 ng/ml/hr) and control groups.
- Clinical features, including blood pressure, proteinuria, potassium, cholesterol levels, and history of hypertension progression, were compared.
Main Results:
- High renin group showed significantly higher rates of accelerated hypertension, high diastolic blood pressure, massive proteinuria, hypokalemia, and high serum cholesterol compared to controls.
- Renovascular hypertension was suspected in 66.7% of the high renin group versus 2.0% of the control group.
- Massive proteinuria and nephrotic syndrome were observed in patients with suspected renovascular hypertension within the high renin group.
Conclusions:
- Elderly patients with high renin hypertension exhibit distinct clinical features, including rapid progression and specific biochemical abnormalities.
- A significant proportion of elderly patients with high renin hypertension likely have underlying renovascular hypertension.
- These findings highlight the importance of investigating renovascular causes in elderly hypertensive patients with high renin activity.
Abstract:
This paper describes clinical features of high renin hypertension in the elderly. Peripheral plasma renin activity ranged from 0 to 20.1 ng/ml/hr in 59 hypertensive in-patients aged 70 to 86. The patients were divided into 2 groups: 9 cases with plasma renin activity greater than or equal to 3.0 ng/ml/hr (high renin group) and the remaining 50 with plasma renin activity less than 3.0 ng/ml/hr (control group). The development of hypertension differed between the 2 groups. Six of the high renin group (66.7%) had a history of acceleration of previously mild hypertension, while only 3 of the control group (6.0%) had this history (p less than 0.01). The frequencies of high diastolic blood pressure (greater than or equal to 120 mmHg), massive proteinuria (at least 3.0 g/day), hypokalemia (serum potassium less than or equal to 3.0 mEq/L) and high serum cholesterol (greater than or equal to 250 mg/100 ml) were significantly greater in the high renin group than in the control group (p less than 0.01, respectively). Renovascular hypertension was suspected in 6 patients from the high renin group (66.7%), as compared with 1 of the control group (2.0%) (p less than 0.001). There was massive proteinuria in 3 of 6 patients with renovascular hypertension in the high renin group and 2 showed nephrotic syndrome. Thus, two-thirds of the elderly patients with high renin hypertension had probable renovascular hypertension with a history of rapid progression of hypertension.