Professor, Department of Medicine and Nephrology, GITAM Institute of Medical Sciences and Research, Visakhapatnam, Andhra Pradesh.
Associate Professor, Department of Medicine and Cardiology, INHS Asvini, Mumbai.
J Assoc Physicians India. 2022 Aug;70(8):11-12. doi: 10.5005/japi-11001-0061.
Most guidelines for hypertension overlook the underlying pathophysiologic basis in deciding 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-center 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, second BP was recorded and 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.
The study included 918 patients with hypertension and 896 cases were finally analyzed. Of these patients, 287 (32.03%) had LRH (<0.51 ng/mL/hr), 412 (45.98%) had HRH (>2.64 ng/mL/hr), while 197 (21.99%) had NRH (0.51-2.64 ng/mL/hr). Renin-guided management caused significant BP reduction. In 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 (p-value < 0.05). In 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 (p-value < 0.05). The number of hypertensives used in patients also reduced with 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 and in reducing the number of antihypertensive drugs.
大多数高血压指南在决定降压药物时忽略了潜在的病理生理基础。根据肾素水平，高血压可分为高肾素型高血压（HRH）、低肾素型高血压（LRH）和正常肾素型高血压（NRH）。本研究检测了高血压人群中的肾素水平，并评估了肾素指导的降压管理对血压（BP）控制的影响。
这是一项单中心前瞻性队列研究。研究纳入了正在服用降压药的原发性高血压（年龄 20-60 岁）患者。记录初始 BP，随后停用所有降压药。2 周后，记录第二次 BP 并采集血浆肾素测定（PRA）样本。所有患者重新服用之前的降压药，并根据 PRA 进一步调整药物。在 LRH 中使用抗 V 药物，如利尿剂和钙通道阻滞剂（CCBs），而在 HRH 中使用β受体阻滞剂和抗肾素药物（Anti R 药物）。
该研究纳入了 918 例高血压患者，最终分析了 896 例。这些患者中，287 例（32.03%）为 LRH（<0.51ng/mL/hr），412 例（45.98%）为 HRH（>2.64ng/mL/hr），197 例（21.99%）为 NRH（0.51-2.64ng/mL/hr）。肾素指导管理显著降低了 BP。在血压控制组中，调整前后的收缩压（SBP）/舒张压（DBP）分别为 133.83±3.36/84.77±3.12 和 123.87±10.59/84.05±1.84（p 值<0.05）。在血压未控制组中，相应的 SBP/DBP 分别为 152.17±2.95/90.36±5.02 和 138±1.23/87.78±0.84（p 值<0.05）。同时，服用的降压药种类也减少了，从服用两种、三种或四种降压药的患者数量减少。
肾素指导的治疗有助于改善控制和未控制高血压患者的血压控制，并减少降压药的使用数量。
Zotero 插件