Usefulness of plasma renin activity value for therapeutic decisions among hypertensive subjects; is Laragh and Alderman idea helpful?

Abstract

The aim of the study was to check if plasma renin activity (PRA) is helpful for therapeutic decisions in arterial hypertension (HT). According to PRA value hypertensive patients should be divided into two subtypes low and high renin (PRA over or below 0.65ng/ml/h). According to Laragh and Alderman algorithm high renin «R» hypertension should be treated by RAA‐system antagonists. Low renin «V» hypertension is connected with sodium‐volume overload and should be treated by diuretics or calcium channel blockers (anti‐«V» drugs). Material and methods: Pra was measured in 95 never treated patients, with HT stage 1 or 2. 59 patients were «high renin», 36‐ «low renin». Irrespectively of PRA patients were randomized to 6 months monotherapy with: quinapril, amlodipine, hydrochlorothiazide, losartan or bisoprolol. Finally four groups were compared for antihypertensive effects: group 1 (high renin, anti‐RAA drugs), group 2 (high renin, anti‐V drugs), group 3 (low renin, anti‐RAA drugs), group 4 (low renin, anti‐V drugs). Before and then after 1, 3 and 6 months of treatment office BP and ABPM were performed. Results: At the baseline no differences between groups were observed in BP (office and 24‐hours monitoring). ANOVA for repeated measurements revealed for all groups significant decrease in SBP and DBP office measurement (p<0.001). After 6 months BP decrease was in: group‐1 (15.1/12.1mmHg), group‐2 (20.5/10.6mmHg), group‐3 (11.6/8.3mmHg), group‐4 (20.6/8,9mmHg). No differences appeared between groups 1‐4 in above effects. 24‐hours ABPM confirmed significant decrease of SBP and DBP (p<0.001 in ANOVA for mean 24‐hours, day and night values) for 4 distinguished groups without of any intergroup differences. ANOVA analysis performed for each of 5 prescribed drugs (each drug in 19 patients) didn't reveal any differences among drugs in SBP and DBP decrease however SBP and DBP drop was significant in office BP and 24‐hours ABPM (p< 0.001). Conclusion: Irrespectively of chosen drug and PRA value we observed similar antihypertensive effect. PRA value shouldn't be recommended as helpful in individualization of antihypertensive treatment.