title: Plasma renin activity and risk of cardiovascular and mortality outcomes among individuals with elevated and nonelevated blood pressure.
abstract: BACKGROUND
  We sought to evaluate plasma renin activity (PRA) levels and risk of mortality and cardiovascular events among individuals with elevated blood pressure [systolic blood pressure (SBP) ≥ 140 mmHg] and those with controlled blood pressure (SBP < 140 mmHg) in a large diverse population.
  
  
  METHODS
  A retrospective cohort study between January 1, 2007, and December 31, 2013, among adults (≥ 18 years) within an integrated health system was conducted. Subjects were categorized by SBP into 2 groups: SBP < 140 mmHg and SBP ≥ 140 mmHg and then further categorized into population-based PRA tertiles within each SBP group. Cox proportional hazard modeling was used to estimate hazard ratios for cardiovascular and mortality outcomes among tertiles of PRA levels.
  
  
  RESULTS
  Among 6,331 subjects, 32.6% had SBP ≥ 140 mmHg. Multivariable hazard ratios and 95% confidence interval for PRA tertiles T2 and T3 compared to T1 in subjects with SBP ≥ 140 mmHg were 1.42 (0.99-2.03) and 1.61 (1.12-2.33) for ischemic heart events; 1.40 (0.93-2.10) and 2.23 (1.53-3.27) for congestive heart failure; 1.10 (0.73-1.68) and 1.06 (0.68-1.66) for cerebrovascular accident; 1.23 (0.94-1.59) and 1.43 (1.10-1.86) for combined cardiovascular events; and 1.39 (0.97-1.99) and 1.35 (0.92-1.97) for all-cause mortality, respectively. Among the SBP < 140 mmHg group, there was no relationship between PRA levels and outcomes.
  
  
  CONCLUSIONS
  Higher PRA levels demonstrated increased risk for ischemic heart events and congestive heart failure and a trend toward higher mortality among individuals with SBP ≥ 140 mmHg but not among those with SBP < 140 mmHg.
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: Simran K
authors.initials: SK
authors.lastname: Bhandari
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Batech
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
authors.forename: Jiaxiao
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Sim
keywords: Cardiovascular outcomes; Epidemiology; Mortality; Plasma renin activity