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Plasma Renin-guided Therapy in Patients of Primary Hypertension on Antihypertensives: A Prospective Cohort Study
Msn Murty1, Rajesh Pandey2, Sibeka Behera3
1Professor, Department of Medicine and Nephrology, GITAM Institute of Medical Sciences and Research, Visakhapatnam, Andhra Pradesh.
Insights
Renin-guided therapy significantly improves blood pressure control in hypertensive patients. This approach also reduces the number of antihypertensive medications needed for effective management.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Hypertension management guidelines often overlook pathophysiologic basis.
- Hypertension can be classified into high-renin (HRH), low-renin (LRH), and normal-renin (NRH) based on plasma renin activity.
- Assessing renin levels can inform targeted antihypertensive strategies.
Purpose of the Study:
- To investigate renin levels in a hypertensive population.
- To evaluate the efficacy of renin-guided antihypertensive management on blood pressure control.
- To determine if renin-based therapy can reduce medication burden.
Main Methods:
- A single-center prospective cohort study involving 918 hypertensive patients (aged 20-60).
- Initial and follow-up blood pressure (BP) measurements were taken after antihypertensive discontinuation and re-initiation.
- Plasma renin assay (PRA) guided medication adjustments, using specific drug classes for LRH and HRH.
Main Results:
- Analysis included 896 patients: 32.03% LRH, 45.98% HRH, 21.99% NRH.
- Renin-guided management significantly reduced BP in both controlled and uncontrolled groups (p < 0.05).
- The number of antihypertensive drugs required per patient decreased post-intervention.
Conclusions:
- Renin-guided therapy is effective for improving BP control in hypertensive patients.
- This strategy aids in optimizing medication regimens, reducing drug count.
- Tailoring antihypertensives based on renin levels offers a valuable therapeutic approach.
Background:
Most guidelines for hypertension overlook the underlying pathophysiologic basis in deciding antihypertensives. Based on renin levels, hypertension may be classified as high-renin hypertension (HRH), low-renin hypertension (LRH), and normal-renin hypertension (NRH). The study examined the renin levels in a hypertensive population and assessed the effect of renin-guided antihypertensive management on blood pressure (BP) control.
Materials And Methods:
This study was a single-center prospective cohort study. Subjects with primary hypertension (aged 20-60 years) on antihypertensives were included in the study. Initial BP was recorded and subsequently, all antihypertensives were discontinued. After 2 weeks, second BP was recorded and plasma renin assay (PRA) sample was collected. All patients were restarted on the previous antihypertensives and further modification of medication was performed based on their PRA. Anti V drugs, such as diuretics and calcium channel blockers (CCBs) were used in LRH while beta-blockers and antirenin drugs (Anti R drugs) were used in HRH.
Results:
The study included 918 patients with hypertension and 896 cases were finally analyzed. Of these patients, 287 (32.03%) had LRH (<0.51 ng/mL/hr), 412 (45.98%) had HRH (>2.64 ng/mL/hr), while 197 (21.99%) had NRH (0.51-2.64 ng/mL/hr). Renin-guided management caused significant BP reduction. In controlled BP group, the systolic BP (SBP)/diastolic BP (DBP) before and after modification were 133.83 ± 3.36/84.77 ± 3.12 and 123.87 ± 10.59/84.05 ± 1.84, respectively (p-value < 0.05). In uncontrolled BP group, the corresponding SBP/DBP were 152.17 ± 2.95/90.36 ± 5.02 and 138 ± 1.23/87.78 ± 0.84, respectively (p-value < 0.05). The number of hypertensives used in patients also reduced with reduction in patients on two, three, or four drugs.
Conclusions:
Renin-guided therapy is useful for improving BP control in both controlled and uncontrolled hypertensive patients and in reducing the number of antihypertensive drugs.
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