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Renin in hypertension: how important as a risk factor?
Insights
Plasma renin levels did not strongly predict severe cardiovascular events in 325 hypertensive patients. High renin was not consistently associated with increased risk when other factors were considered.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Hypertension is a major risk factor for cardiovascular disease.
- Plasma renin activity (PRA) has been investigated as a potential predictor of cardiovascular events.
- Previous studies suggested a link between high PRA and increased cardiovascular risk.
Purpose of the Study:
- To analyze the relationship between plasma renin levels and the incidence of severe cardiovascular complications in patients with various types of hypertension.
- To determine if plasma renin activity is an independent risk factor for cardiovascular events in hypertensive individuals.
Main Methods:
- Analysis of plasma renin activity in 325 hypertensive patients (1963-1968).
- Patients categorized into low, normal, and high renin groups.
- Follow-up for 5 to 10 years to record severe cardiovascular complications (coronary thrombosis, stroke, ruptured aortic aneurysm).
- Consideration of various hypertension types: essential, malignant, secondary to renal disease, and renal artery obstruction.
Main Results:
- The incidence of severe cardiovascular complications was 23.6%, 20.4%, and 44.7% in the low, normal, and high renin groups, respectively.
- These findings suggest that high renin levels alone may not be a significant independent risk factor.
- The predictive value of renin may be influenced by other clinical parameters.
Conclusions:
- Plasma renin levels, when considered in isolation, may not be a reliable predictor of severe cardiovascular complications in hypertensive patients.
- Factors such as diastolic pressure, kidney function, hypertension management, and atherosclerotic burden are crucial for risk assessment.
- Further research is needed to elucidate the complex interplay of renin and cardiovascular risk in diverse hypertensive populations.
Abstract:
An analysis of the plasma renin levels in relation to the incidence of severe cardiovascular complications (coronary thrombosis, stroke, ruptured aortic aneurysm) was made in 325 patients with various types of hypertension. These patients had one to four measurements of plasma renin activity taken under standard conditions of sodium intake and posture in the period 1963-68. The follow-up was 5 to 10 years in the four groups of hypertensive patients (essential hypertension, malignant hypertension, hypertension secondary to renal parenchymatous disease and hypertension caused by, or associated with, renal artery obstruction). For all 325 patients, the incidence of such complications was 23.6, 20.4 and 44.7% in the low, normal and high renin groups. These findings are at variance with the claim that renin constitutes a serious risk factor in hypertensive patients, especially if it is isolated from other parameters such as the level of diastolic pressure, the adequacy of kidney function, the effectiveness of dietary and drug management of hypertension, and especially the presence or absence of atherosclerotic lesions of the large vessels at the time of the renin determination.