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Updated: May 26, 2026

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
08:35

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Published on: May 26, 2022

Renin-Guided Risk Stratification and Therapy in Hypertension to Reduce Major Adverse Cardiovascular Outcomes

Cheng-Hsuan Tsai1,2,3, Yu-Ching Chang4, Chin-Chen Chang5

  • 1Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Medrxiv : the Preprint Server for Health Sciences
|May 25, 2026
PubMed

Insights

Plasma renin activity is a key indicator for major adverse cardiovascular events (MACE) in hypertension patients. Tailoring treatment based on renin levels, using mineralocorticoid receptor antagonists for low renin and renin-angiotensin system inhibitors for high renin, may improve outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Hypertension Research

Background:

  • Risk stratification in hypertension is complex, with the prognostic role of plasma renin activity (PRA) in guiding therapy not fully established.
  • Understanding PRA's association with cardiovascular events is crucial for optimizing hypertension management.

Purpose of the Study:

  • To investigate the prognostic value of plasma renin activity in predicting major adverse cardiovascular events (MACE).
  • To evaluate differential treatment responses to mineralocorticoid receptor antagonists (MRAs) and renin-angiotensin system inhibitors (RASIs) based on renin levels.

Main Methods:

  • A multicenter retrospective cohort study involving 16,600 patients with hypertension.
  • Analysis of plasma renin activity as a continuous variable using restricted cubic splines.
  • A 6-month landmark analysis comparing MRA initiation versus baseline RASI use.

Main Results:

  • A U-shaped association was observed between continuous renin levels and MACE, with the lowest risk at 1.17 ng/mL/h.
  • Both low (<0.3 ng/mL/h) and high (>3.0 ng/mL/h) renin levels were independently associated with increased MACE risk.
  • MRA initiation showed a graded risk reduction, most pronounced in low-renin patients (HR=0.75), while RASI use benefited high-renin patients (HR=0.76).

Conclusions:

  • Plasma renin activity serves as a prognostic biomarker for MACE in hypertension.
  • A renin-guided treatment strategy, favoring MRAs in low-renin and RASIs in high-renin hypertension, may personalize care and reduce cardiovascular risk.
Abstract

Keywords:
hypertensionmineralocorticoid receptor antagonistreninrenin-angiotensin systemtreatment

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