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Renin-sodium profile and its therapeutical implications in arterial hypertension
Insights
This study classified essential hypertension patients into four groups based on plasma angiotensin II and exchangeable sodium levels. Identifying these renin-sodium profiles helps tailor treatments for better blood pressure control.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Essential hypertension (EH) is a complex condition with varied underlying pathophysiology.
- Understanding the roles of the renin-angiotensin system and sodium balance is crucial for EH management.
Purpose of the Study:
- To categorize patients with moderate to severe essential hypertension based on plasma angiotensin II (AII) and exchangeable sodium (ENa) levels.
- To investigate the relationship between these profiles and response to antihypertensive therapies.
Main Methods:
- Plasma AII and ENa levels were measured in 35 patients with essential hypertension.
- Patients were grouped based on high/normal/low AII and normal/high ENa.
- Treatment responses to propranolol and thiabutazid were assessed.
Main Results:
- Four distinct patient groups were identified based on AII and ENa levels.
- High AII/normal ENa patients responded to propranolol (renin-dependent EH).
- Normal or low AII/high ENa patients responded to thiabutazid (volume-sodium-dependent EH).
- Mixed forms showed response to combined therapy.
Conclusions:
- Exchangeable sodium determination is a reliable index for renin profiling in essential hypertension.
- A renin-sodium profile aids in identifying pathophysiological subtypes of arterial hypertension.
- This profiling can guide personalized therapeutic strategies for essential hypertension.
Abstract:
In 35 patients with moderate or severe essential hypertension (EH) four groups could be identified by plasma angiotensin II (AII) (formula: see text) and by exchangeable sodium (ENa) (formula: see text) determination. In 6 patients with high AII (135.9 pg/ml +/- 26.29) and normal ENa (98.83% +/- 1.40) propranolol significantly lowered both blood pressure (BP) and AII, suggesting that these forms of EH are renin dependent. In 15 patients with normal AII (36.43 pg/ml +/- 2.27) and high ENa (124.23 +/- 2.78) and in 6 patients with low AII (8.36 pg/ml +/- 3.39) and high ENa (125.16% +/- 5.71) the maximal hypotensive effect was achieved after ENa reduction with thiabutazid. These forms of EH appear to be volume-sodium dependent. In 8 patients with increase of both AII (76.53 pg/ml +/- 5.72) and ENa (112% +/- 1.72), propranolol associated with thiabutazid lowered the BP, AII and ENa suggesting that these cases are mixed forms. ENa determination appears to be a reliable index for renin profiling; such a renin-sodium profile allows to identify some pathophysiologic forms of arterial hypertension.