Thurston H, Bing R F, Pohl J E, Swales J D
Q J Med. 1978 Jul;47(187):325-37.
It has been claimed that measurement of renin levels in patients with essential hypertension enables identifiable subgroups of patients to be demarcated and that these subgroups exhibit important differences in prognosis and response to therapy. Accordingly, plasma renin activity (PRA) was measured in 181 patients referred to hospital outpatients for treatment of hypertension. Fifteen of these were excluded from study because of abnormality of renal function, an abnormal pyelogram or incidental disease. PRA of the remainder showed a smooth unimodal distribution with a 'tail' of high values (17%) which lay above the range of values observed in normotensive subjects. Following seven days treatment with bendrofluazide the percentage rise in PRA was much less than that of age-matched controls. A group of 55 patients (33%) fell below the range encountered in normotensive matched subjects treated similarly, although the distribution of PRA was still smooth and unimodal. Patients were divided into 'high', 'normal' and 'low' renin subgroups. Whilst there were significant differences in age between the high, normal and low renin groups, there were no significant differences in basal blood pressure, response to diuretics or beta blockers. It is concluded that renin levels in hypertension are influenced by several factors and that any attempt to subdivide patients into renin subgroups is therefore arbitrary. Measurement of renin does not significantly assist predicting the blood pressure response to either diuretics or beta-blockers combined with diuretics.
有人声称，对原发性高血压患者的肾素水平进行测量，可以划分出可识别的患者亚组，并且这些亚组在预后和对治疗的反应方面表现出重要差异。因此，对181名到医院门诊治疗高血压的患者进行了血浆肾素活性（PRA）测量。其中15名患者因肾功能异常、肾盂造影异常或并发疾病而被排除在研究之外。其余患者的PRA呈平滑的单峰分布，有一个高值“尾巴”（17%），高于正常血压受试者观察到的值范围。用苄氟噻嗪治疗7天后，PRA的升高百分比远低于年龄匹配的对照组。一组55名患者（33%）低于类似治疗的正常血压匹配受试者所遇到的范围，尽管PRA的分布仍然是平滑的单峰分布。患者被分为“高”、“正常”和“低”肾素亚组。虽然高、正常和低肾素组之间在年龄上存在显著差异，但在基础血压、对利尿剂或β受体阻滞剂的反应方面没有显著差异。得出的结论是，高血压患者的肾素水平受多种因素影响，因此，将患者细分为肾素亚组的任何尝试都是随意的。测量肾素对预测利尿剂或与利尿剂联合使用的β受体阻滞剂的血压反应没有显著帮助。
