Low-renin status in therapy-resistant hypertension: a clue to efficient treatment.

Abstract

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.

SETTING:

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.

DESIGN AND INTERVENTIONS:

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.

MAIN OUTCOME MEASURES:

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.

CONCLUSION:

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.

• Authors: Ivar K Eide, Peter A Torjesen, Anders Drolsum, Almira Babovic, Nils P Lilledahl
• Journal: Journal of hypertension (J Hypertens) Vol. 22 Issue 11 Pg. 2217-26 (Nov 2004) ISSN: 0263-6352 [Print] England
• PMID: 15480108 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Antihypertensive Agents
• Drug Combinations
• Mineralocorticoid Receptor Antagonists
• Hydrochlorothiazide
• amiloride, hydrochlorothiazide drug combination
• Amiloride
• Renin
• Potassium

Topics

• Adenoma (epidemiology)
• Adrenal Gland Neoplasms (epidemiology)
• Adult
• Aged
• Aged, 80 and over
• Amiloride (therapeutic use)
• Antihypertensive Agents (therapeutic use)
• Cross-Over Studies
• Drug Combinations
• Drug Resistance
• Female
• Humans
• Hydrochlorothiazide (therapeutic use)
• Hyperaldosteronism (epidemiology)
• Hypertension (blood, drug therapy, epidemiology)
• Male
• Middle Aged
• Mineralocorticoid Receptor Antagonists (therapeutic use)
• Potassium (blood)
• Prevalence
• Prospective Studies
• Renin (blood)
• Retinal Diseases (epidemiology)