Efficacy of antihypertensive treatment based on plasma renin activity: An open label observational study.
BACKGROUND
We investigated the extent of blood pressure (BP) reduction and control (<140/90 mmHg) in patients treated with appropriate or inappropriate drugs according to their plasma renin activity (PRA) level (natriuretic drugs and renin-angiotensin system blockers for low-renin and high-renin hypertension, respectively).


METHODS
One hundred and seventy Caucasian untreated hypertensive patients (61 females), aged 18-70 years, participated to the study. Patients with secondary hypertension, diabetes or established cardiovascular or renal disease were excluded. The physician prescribed an antihypertensive monotherapy chosen among all drug classes, unaware of patient's PRA levels. We compared effect of an inappropriate or appropriate drug, evaluating BP values after a month of treatment.


RESULTS
Rate of BP control was not significantly higher in patients treated with an appropriate drug than the others (38% vs 29%, p=0.24). However, in a regression analysis, final diastolic BP (DBP) was lower in subjects treated with an appropriate drug (beta=-2.84, p=0.03).


CONCLUSIONS
The present study does not clearly support the use of PRA in a general population of hypertensive patients to optimize BP control. However, the greater efficacy of a drug appropriate to PRA in reducing DBP may be clinically helpful in young hypertensive patients. Future studies are warranted to evaluate if PRA determination enhances the therapeutic success in patients with predominantly high values of DBP.
Leotta
Giannina
G
Hypertension Unit, Department of Medicine and Experimental Oncology, University of Turin, Torino, Italy.
Rabbia
Franco
F
Testa
Elisa
E
Totaro
Silvia
S
Abram
Sara
S
Milan
Alberto
A
Mulatero
Paolo
P
Veglio
Franco
F
D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood*; D012084:Renin-Angiotensin System / Q000187:drug effects
D000959:Antihypertensive Agents; D012083:Renin