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Renin subgroups in essential hypertension.

J I Drayer, M A Weber, J H Laragh

    Clinical and Experimental Hypertension. Part A, Theory and Practice
    |January 1, 1982
    PubMed
    Summary
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    Essential hypertension can be classified into low, medium, and high renin subgroups. Low renin patients were older, predominantly women, and showed increased adrenal sensitivity. High renin patients had volume contraction and adrenal unresponsiveness.

    Area of Science:

    • Nephrology
    • Endocrinology
    • Cardiovascular Medicine

    Background:

    • Essential hypertension is a complex condition with varying pathophysiological mechanisms.
    • Plasma renin activity (PRA) and urinary sodium excretion are key factors in blood pressure regulation.
    • Understanding renin subgroups can elucidate different hypertension phenotypes.

    Purpose of the Study:

    • To classify essential hypertension patients into renin subgroups using a nomogram.
    • To investigate the clinical and biochemical characteristics of these subgroups.
    • To explore differences in adrenal sensitivity to angiotensin II.

    Main Methods:

    • A nomogram based on plasma renin activity and urinary sodium excretion was used.
    • 956 patients with essential hypertension were classified into low, medium, and high renin subgroups.

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  • Clinical parameters (age, sex, blood pressure) and biochemical markers (creatinine clearance, albumin, hematocrit, electrolytes) were analyzed.

    • Main Results:

    • Low renin subgroup (27%): Older, more women, higher systolic BP, lower creatinine clearance, albumin, hematocrit, potassium. Showed increased adrenal sensitivity to angiotensin II.
    • High renin subgroup (11%): Younger, higher albumin and hematocrit. Characterized by volume contraction and relative adrenal unresponsiveness to angiotensin II.
    • Aldosterone excretion was similar across subgroups, suggesting differential adrenal sensitivity.

    Conclusions:

    • Essential hypertension exhibits distinct renin subgroups with unique clinical and biochemical profiles.
    • Age and sex significantly influence parameters in low renin hypertension.
    • Differences in adrenal sensitivity to angiotensin II may play a role in sustaining hypertension across subgroups.