Measurement of plasma renin concentration instead of plasma renin activity decreases the positive aldosterone-to-renin ratio tests in treated patients with essential hypertension

Thiazide diuretics such as bendrofluazide and chlorothiazide have been used for nearly 20 years in the treatment of hypertension. They have been regarded as rather weak antihypertensive agents which could be used alone only in mild hypertension and otherwise as adjuvants to more potent drugs in more serious cases.1 There are however some patients with ‘essential’ hypertension who are very sensitive to diuretics and in whom the pressure may be brought down to normal by a thiazide2 or spironolactone3 even when it is initially considerably raised. Furthermore a few patients who are responsive to thiazides are strikingly unresponsive to non-diuretic antihypertensive drugs. Patients particularly likely to respond to a thiazide diuretic4 or spironolactone3 commonly have low plasma renin activity and this occurs in about 25% of patients with essential hypertension.5 Since plasma renin activity is not routinely estimated it is simplest to identify these patients by observing the response to an adequate trial of a thiazide.

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The relationship between plasma renin activity and serum lipid profiles in patients with primary arterial hypertension

Journal of the Renin-Angiotensin-Aldosterone System ◽

10.1177/1470320318810022 ◽

2018 ◽

Vol 19 (4) ◽

pp. 147032031881002 ◽

Cited By ~ 3

Author(s):

Tomasz Pizoń ◽

Marek Rajzer ◽

Wiktoria Wojciechowska ◽

Małgorzata Wach-Pizoń ◽

Tomasz Drożdż ◽

...

Keyword(s):

Plasma Renin Activity ◽

Arterial Hypertension ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Plasma Renin ◽

Serum Levels ◽

Renin Activity ◽

Serum Aldosterone ◽

Primary Arterial Hypertension ◽

Aldosterone To Renin Ratio

Introduction: The aim of the study was to evaluate clinical and biochemical differences between patients with low-renin and high-renin primary arterial hypertension (AH), mainly in reference to serum lipids, and to identify factors determining lipid concentrations. Materials and methods: In untreated patients with AH stage 1 we measured plasma renin activity (PRA) and subdivided the group into low-renin (PRA < 0.65 ng/mL/h) and high-renin (PRA ⩾ 0.65 ng/mL/h) AH. We compared office and 24-h ambulatory blood pressure, serum aldosterone, lipids and selected biochemical parameters between subgroups. Factors determining lipid concentration in both subgroups were assessed in regression analysis. Results: Patients with high-renin hypertension ( N = 58) were characterized by higher heart rate ( p = 0.04), lower serum sodium ( p < 0.01) and aldosterone-to-renin ratio ( p < 0.01), and significantly higher serum aldosterone ( p = 0.03), albumin ( p < 0.01), total protein ( p < 0.01), total cholesterol ( p = 0.01) and low-density lipoprotein cholesterol (LDL-C) ( p = 0.04) than low-renin subjects ( N = 39). In univariate linear regression, only PRA in the low-renin group was in a positive relationship with LDL-C ( R2 = 0.15, β = 1.53 and p = 0.013); this association remained significant after adjustment for age, sex, and serum albumin and aldosterone concentrations. Conclusions: Higher serum levels of total and LDL-C characterized high-renin subjects, but the association between LDL-C level and PRA existed only in low-renin primary AH.

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Solitary Kidney and Ageing as Causes of Low Renin and Aldosterone Concentrations: Relevance to ‘Low-Renin’ Essential Hypertension

Clinical Science ◽

10.1042/cs051177s ◽

1976 ◽

Vol 51 (s3) ◽

pp. 177s-180s ◽

Cited By ~ 1

Author(s):

R. Gordon ◽

Freda Doran ◽

M. Thomas ◽

Frances Thomas ◽

P. Cheras

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Plasma Renin Activity ◽

Plasma Volume ◽

Plasma Renin ◽

Renin Activity ◽

Dietary Sodium ◽

Sodium Restriction ◽

Normotensive Subjects ◽

The Mean

1. As experimental models of reduced nephron population in man, (a) twelve men aged 15–32 years who had one kidney removed 1–13 years previously and (b) fourteen normotensive men aged 70–90 years were studied. Results were compared with those in eighteen normotensive men aged 18–28 years and eleven men aged 19–33 years with essential hypertension. 2. While the subjects followed a routine of normal diet and daily activity, measurements were made, after overnight recumbency and in the fasting state, of plasma volume and renin activity on one occasion in hospital and of blood pressure on five to fourteen occasions in the home. Blood pressure was also measured after standing for 2 min and plasma renin activity after 1 h standing, sitting or walking. Twenty-four hour urinary aldosterone excretion was also measured. 3. The measurements were repeated in the normotensive subjects and subjects in (a) and (b) above after 10 days of sodium-restricted diet (40 mmol of sodium/day). 4. The mean plasma renin activity (recumbent) in essential hypertensive subjects was higher than in normotensive subjects. In subjects of (a) and (b) above, it was lower than normotensive subjects, and was not increased by dietary sodium restriction in subjects of (a). 5. The mean aldosterone excretion level was lower in old normotensive subjects than in the other groups, and increased in each group after dietary sodium restriction. 6. Mean plasma volume/surface area was not different between the four groups and in normotensive, essential hypertensive and nephrectomized subjects but not subjects aged 70–90 years was negatively correlated with standing diastolic blood pressure.

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Association between plasma renin activity and metabolic cardiovascular risk factors in essential hypertension

Journal of Internal Medicine ◽

10.1046/j.1365-2796.1996.414756000.x ◽

1996 ◽

Vol 239 (1) ◽

pp. 49-55 ◽

Cited By ~ 6

Author(s):

K. ALLIKMETS ◽

T. PARIK ◽

R. TEESALU

Keyword(s):

Risk Factors ◽

Essential Hypertension ◽

Cardiovascular Risk ◽

Plasma Renin Activity ◽

Cardiovascular Risk Factors ◽

Plasma Renin ◽

Renin Activity

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Effect of Atenolol(Tenormin®) on Blood Pressure and Plasma Renin Activity in Essential Hypertension

Korean Circulation Journal ◽

10.4070/kcj.1982.12.1.145 ◽

1982 ◽

Vol 12 (1) ◽

pp. 145

Author(s):

Soon Kyu Suh ◽

Sae Wha Yoo ◽

Soon Chang Park ◽

Joon Sock Kim ◽

Kyung Ho Kang ◽

...

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Plasma Renin Activity ◽

Plasma Renin ◽

Renin Activity

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Are Racial Differences in Essential Hypertension Due to Different Pathogenetic Mechanisms?

Clinical Science ◽

10.1042/cs055383s ◽

1978 ◽

Vol 55 (s4) ◽

pp. 383s-386s ◽

Cited By ~ 2

Author(s):

P. S. Sever ◽

W. S. Peart ◽

T. W. Meade ◽

I. B. Davies ◽

D. Gordon ◽

...

Keyword(s):

Essential Hypertension ◽

Plasma Renin Activity ◽

Racial Differences ◽

Plasma Renin ◽

Urinary Sodium Excretion ◽

Renin Activity ◽

Plasma Noradrenaline ◽

Noradrenaline Concentration ◽

Blacks And Whites ◽

Made In

1. Plasma noradrenaline concentration and plasma renin activity were measured in a control, British, urban population (n = 115) in which blacks were matched for age and sex with whites. 2. Similar measurements were made in subjects with essential hypertension (77 white and 23 black), and 48 healthy normotensive white civil servants. 3. In controls blood pressure was significantly higher in blacks; it correlated with age in both races and with pulse rate in blacks. There were no significant racial differences in plasma noradrenaline which was positively correlated with age in both blacks and whites. Mean plasma renin activity was 55% lower in blacks, and this difference was not related to urinary sodium excretion. 4. In hypertensive subjects plasma noradrenaline positively correlated with age in blacks. This relationship was not found in whites in whom 20% of young hypertensive subjects (<45 years) had significantly raised plasma noradrenaline. Plasma renin activity was again significantly lower in blacks. In white hypertensives plasma noradrenaline and renin activity were significantly correlated. 5. There may be racial differences in the pathogenesis of essential hypertension.

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