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Plasma renin predicts success of antihypertensive drug withdrawal
G Y Ho1, M D Blaufox, S Wassertheil-Smoller
1Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, New York 10461.
Insights
Low plasma renin activity (PRA) predicts a reduced likelihood of maintaining blood pressure control after stopping antihypertensive medication. Higher PRA levels are associated with a greater chance of remaining off medication successfully.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Pharmacology
Background:
- Hypertension management often involves multiple medications.
- Discontinuation of antihypertensive drugs requires careful monitoring.
- Plasma renin activity (PRA) is a key factor in blood pressure regulation.
Purpose of the Study:
- To investigate the relationship between plasma renin activity (PRA) and the ability to maintain blood pressure control after discontinuing antihypertensive medication.
- To determine if baseline PRA levels can predict success in remaining off blood pressure medication.
Main Methods:
- A cohort of patients with previously controlled hypertension were enrolled in a study involving medication discontinuation and dietary interventions.
- Patients were randomized to different intervention groups: no intervention, sodium restriction, or weight reduction (for obese patients).
- Plasma renin activity (PRA) was measured in a subset of patients, and blood pressure was monitored for 56 weeks to assess the need for restarting medication.
Main Results:
- Patients with lower plasma renin activity (PRA) (below the median of 53.3 ng/100 mL/h) had a significantly lower success rate in remaining off antihypertensive medication.
- Cox regression analysis revealed that a decrease in log PRA was associated with a 2.78-fold increased risk of needing to restart medication.
- This inverse relationship between PRA and the risk of returning to medication was independent of dietary interventions and early blood pressure changes.
Conclusions:
- Low plasma renin activity (PRA) is a significant predictor of difficulty in maintaining blood pressure control without antihypertensive drugs.
- Patients with low PRA are less likely to successfully discontinue their blood pressure medication compared to those with high PRA.
- PRA measurement may aid in predicting the success of antihypertensive medication withdrawal in hypertensive patients.
Abstract:
This study examined the relationship of plasma renin activity (PRA) to the likelihood of maintaining blood pressure control after discontinuation of antihypertensive medication. Patients whose blood pressure was previously treated and controlled in the Hypertension Detection and Follow-up Program were enrolled in the Dietary Intervention Study of Hypertension. After stratification by obesity, patients were randomized to discontinue medication with no dietary intervention, sodium restriction, or weight reduction for the obese. Among 496 subjects in the Dietary Intervention Study of Hypertension, 75 were randomly selected for PRA measurement at 4 months after intervention, and all had their blood pressure under control at that time. Patients were followed up for 56 weeks after randomization. The endpoint was return to antihypertensive medication due to elevated diastolic blood pressure. Kaplan-Meier survival analysis showed that subjects with PRA < or = 53.3 ng/100 mL/h, the median level, had a lower cumulative success rate for remaining off antihypertensive drug than those with PRA above the median (P = .046). In Cox regression analysis controlling for 24-h urinary sodium level, baseline diastolic blood pressure, age, sex, race, obesity, and dietary intervention group, a unit decrease in log PRA was associated with a 2.78-fold increase in risk of returning to drug (P = .006); this inverse relationship was independent of dietary intervention and change in diastolic blood pressure in the first 4 months before PRA was measured. The data indicate that patients with low PRA are less likely to maintain blood pressure control without drugs than patients with high PRA.