title: Renin predicts diastolic blood pressure response to nonpharmacologic and pharmacologic therapy.
abstract: OBJECTIVE
  Plasma renin activity was measured at baseline and 6 months in a trial of nonpharmacologic therapy of mild hypertension to determine whether plasma renin activity predicts the diastolic blood pressure (DBP) response to nonpharmacologic therapy.
  
  
  METHODS
  Randomized controlled trial of volunteers from the general community with mild hypertension (DBP between 90 and 100 mm Hg), off all antihypertensive therapy at baseline, treated in special research clinics (n = 593).
  
  
  METHODS
  Subjects were randomly assigned to usual, weight loss, or low sodium/high potassium diet and then randomly assigned to receive placebo, chlorthalidone, or atenolol.
  
  
  METHODS
  Renin was analyzed as plasma renin activity and as a renin index (logarithm of 24-hour urinary sodium excretion times logarithm of plasma renin activity) (593 patients at baseline and 6 months) to correct for varied sodium intakes. The DBP was measured using the random zero device.
  
  
  RESULTS
  Change in DBP at 6 months could be predicted from baseline plasma renin activity or renin index. The DBP was decreased after 6 months of therapy by 2 mm Hg for each unit increase in baseline plasma renin activity and by 0.16 mm Hg for each unit increase in baseline renin index. Patients in the highest renin index quartile had a greater DBP response to atenolol therapy, and patients in the lowest renin index quartile had a greater DBP response to chlorthalidone therapy. Weight loss diet achieved a greater reduction in DBP in patients with higher baseline renin index and had an additive effect on DBP response in both of the drug groups. Patients on a weight loss diet receiving placebo in the highest baseline renin index quartile had a reduction in DBP of 12.4 mm Hg, compared with 4.4 mm Hg in the lowest baseline renin index quartile (P = .009). A low sodium/high potassium diet had a lesser effect than a weight loss diet on pharmacologic therapy. As with the weight loss diet, patients on a low sodium/high potassium diet in the highest baseline renin index quartile had a greater reduction in DBP than patients in the lowest baseline renin index quartile.
  
  
  CONCLUSIONS
  These data suggest a significant relationship between baseline levels of plasma renin index and the likelihood of success of nonpharmacologic treatment of hypertension.
authors.affiliation: Department of Nuclear Medicine, Albert Einstein College of Medicine, Bronx, NY 10461.
authors.forename: M D
authors.initials: MD
authors.lastname: Blaufox
authors.forename: H B
authors.initials: HB
authors.lastname: Lee
authors.forename: B
authors.initials: B
authors.lastname: Davis
authors.forename: A
authors.initials: A
authors.lastname: Oberman
authors.forename: S
authors.initials: S
authors.lastname: Wassertheil-Smoller
authors.forename: H
authors.initials: H
authors.lastname: Langford
mesh_terms: D000328:Adult; D000368:Aged; D001262:Atenolol / Q000627:therapeutic use; D002752:Chlorthalidone / Q000627:therapeutic use; D003971:Diastole; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D008875:Middle Aged; D012044:Regression Analysis; D012083:Renin / Q000097:blood*; D012982:Sodium, Dietary / Q000008:administration & dosage; D015431:Weight Loss
chemical_list: D012982:Sodium, Dietary; D001262:Atenolol; D012083:Renin; D002752:Chlorthalidone