Renin-guided therapy helpful for reducing BP and number of drugs in patients of hypertension
Renin-guided therapy is helpful for improving blood pressure (BP) control and reducing number of medicines among patients with controlled and un controlled hypertension, according to a recent study published in the Journal of the Association of Physicians of India.
Most guidelines for hypertension overlook the underlying pathophysiologic basis in deciding on antihypertensives. Based on renin levels, hypertension may be classified as high-renin hypertension (HRH), low-renin hypertension (LRH), and normal-renin hypertension (NRH). The study examined the renin levels in a hypertensive population and assessed the effect of renin-guided antihypertensive management on blood pressure (BP) control.
This study was a single-centre prospective cohort study. Subjects with primary hypertension (aged 20–60 years) on antihypertensives were included in the study. Initial BP was recorded and subsequently, all antihypertensives were discontinued. After 2 weeks, a second BP was recorded and a plasma renin assay (PRA) sample was collected. All patients were restarted on the previous antihypertensives and further modification of medication was performed based on their PRA. Anti-V drugs, such as diuretics and calcium channel blockers (CCBs) were used in LRH while beta-blockers and antirenin drugs (Anti R drugs) were used in HRH.
Results:
- The study included 918 patients with hypertension and 896 cases were finally analyzed.
- Of these patients, 287 had LRH had HRH while 197 had NRH.
- Renin-guided management caused significant BP reduction.
- In the controlled BP group, the systolic BP (SBP)/diastolic BP (DBP) before and after modification were 133.83 ± 3.36/84.77 ± 3.12 and 123.87 ± 10.59/84.05 ± 1.84, respectively
- In the uncontrolled BP group, the corresponding SBP/DBP were 152.17 ± 2.95/90.36 ± 5.02 and 138 ± 1.23/87.78 ± 0.84, respectively
- The number of hypertensives used in patients also reduced with the reduction in patients on two, three, or four drugs.
Renin-guided therapy is useful for improving BP control in both controlled and uncontrolled hypertensive patients in reducing the number of antihypertensive drugs.
Reference:
MSN Murty et al. Plasma Renin-guided Therapy in Patients of Primary Hypertension on Antihypertensives: A Prospective Cohort Study. DOI: 10.5005/japi-11001-0061
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