Beta adrenergic blockers lower renin in patients treated with ACE inhibitors and diuretics.
OBJECTIVE
To examine the effect of concomitant intake of beta blockers with angiotensin converting enzyme (ACE) inhibitors, diuretics, or both on plasma renin concentrations in a population based sample (MONICA survey, Augsburg, Germany).


METHODS
728 individuals were studied, of whom 171 were treated using monotherapy (ACE inhibitor (n = 21), diuretic (n = 10), or beta blocker (n = 72)), or combination treatment (ACE inhibitor + diuretic (n = 32), ACE inhibitor + beta blocker (n = 7), diuretic + beta blocker (n = 22), ACE inhibitor + diuretic + beta blocker (n = 7)). The remaining 557 individuals were untreated. Indications for treatment were hypertension (75%), coronary artery disease with (12%) or without (3%) hypertension, or unknown (10%).


RESULTS
Mean (SEM) renin concentrations in individuals treated with an ACE inhibitor (41 (8) mU/l), a diuretic (41 (10) mU/l), or the combination of an ACE inhibitor and a diuretic (54 (10) mU/l) were raised compared with untreated individuals (17 (1) mU/l; p < 0.05 each). Monotherapy with a beta blocker, however, decreased mean renin concentrations (12 (1) mU/l; p < 0.01 v untreated). Renin concentrations in individuals taking a beta blocker with either an ACE inhibitor (21 (8) mU/l), or a diuretic (22 (4) mU/l), or with both an ACE inhibitor and a diuretic (21 (7) mU/L), were significantly lower compared with renin concentrations in groups not receiving beta blocker treatment (p < 0.05 each).


CONCLUSIONS
These data suggest that the upregulation of renin by treatment with ACE inhibitors, diuretics, or both can be largely prevented by concomitant beta blocker treatment.
Holmer
S R
SR
Klinik und Poliklinik für Innere Medizin II, University of Regensburg, Germany.
Hense
H W
HW
Danser
A H
AH
Mayer
B
B
Riegger
G A
GA
Schunkert
H
H
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use; D017298:Bisoprolol / Q000627:therapeutic use; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy*; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D012083:Renin / Q000097:blood*; D018709:Statistics, Nonparametric
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D001262:Atenolol; D012083:Renin; D008790:Metoprolol; D017298:Bisoprolol