Low-renin status in therapy-resistant hypertension: a clue to efficient treatment.
OBJECTIVE
Therapy resistance is an enduring problem in clinical hypertension. Our aims were to estimate: (1) the contribution of a low-renin status in therapy resistance; (2) whether such status could give a clue to more successful treatment; and (3) the contribution by adrenal cortical adenomas and by primary aldosteronism.


METHODS
Patients were referred from general and internal medicine practices following written invitations and included consecutively. Participants were examined and followed-up on an outpatient basis.


METHODS
Patients were divided according to renin status. Low-renin patients were treated with an aldosterone inhibitor in a prospective, randomized, placebo-controlled, double-blind, cross-over study.


METHODS
Prevalence of low-renin status in therapy resistance. Blood pressure and hormonal responses to specific treatment. Numbers of adrenocortical adenomas and primary aldosteronism.


RESULTS
In 90 treatment-resistant hypertensive, 67% had plasma renin activity (PRA) below 0.5 nmol/l per hour. Of the 60 low-renin patients, 38 were studied on a fixed combination of amiloride and hydrochlorothiazide. Three weeks' treatment reduced blood pressure by 31/15 mmHg compared to placebo (P < or = 0.0001). Serum aldosterone and plasma renin activity increased substantially during active treatment. Through the subsequent 6-12 months of open treatment, seven patients (18%) showing an escape phenomenon had their high blood pressure effectively treated by extra amiloride. Of the 60 low-renin patients, eight had adrenal adenoma.


CONCLUSIONS
A low-renin status characterized two-thirds of patients with treatment-resistant hypertension, who could be treated efficiently by aldosterone inhibition. Patients with an escape phenomenon (18%) could effectively be treated by increasing the aldosterone inhibitor. Low-renin hypertensives had high prevalence of adrenocortical adenomas and primary aldosteronism.
Department of Medicine, Ullevål University Hospital, Oslo, Norway. ivar.eide@tiscali.no
Ivar K
IK
Eide
Peter A
PA
Torjesen
Anders
A
Drolsum
Almira
A
Babovic
Nils P
NP
Lilledahl
D000236:Adenoma / Q000453:epidemiology; D000310:Adrenal Gland Neoplasms / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000584:Amiloride / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004338:Drug Combinations; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D006929:Hyperaldosteronism / Q000453:epidemiology; D006973:Hypertension / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D011188:Potassium / Q000097:blood; D015995:Prevalence; D011446:Prospective Studies; D012083:Renin / Q000097:blood*; D012164:Retinal Diseases / Q000453:epidemiology
D000959:Antihypertensive Agents; D004338:Drug Combinations; D000451:Mineralocorticoid Receptor Antagonists; D006852:Hydrochlorothiazide; C010247:amiloride, hydrochlorothiazide drug combination; D000584:Amiloride; D012083:Renin; D011188:Potassium