Antihypertensive Response to Thiazide Diuretic or Angiotensin Receptor Blocker in Elderly Hypertensives Is Not Influenced by Pretreatment Plasma Renin Activity

Abstract

Baseline PRA is not a useful guide to the BP responses of initial combination V/HCTZ in elderly individuals with systolic hypertension.

Hypertension

“…61,62 In addition, Gupta et al observed that African Americans, who on average have lower renin levels compared with Caucasians, 63 responded less well to atenolol. 64 Yet, others observed either no role for baseline renin, 65 or at most a weak trend. [66][67][68] Moreover, the BP decreases for a given baseline renin level (uncorrected for salt intake) varied >40 mm Hg.…”

“…In addition, a uniform definition of high renin (plasma renin activity/plasma renin concentration) is not available and clearly complicated by the intake of salt, sex, ethnicity, and the use RAAS-affecting drugs. 61,65,67 Thus, although in general it is probably true that patients with high renin levels respond better to RAAS blockers (for instance, patients pretreated with a diuretic, which activates the RAAS), the variation in renin is such (not even taking into consideration the additional variation at the tissue level!) that it is of limited practical use for the individual patient.…”

Renin and Aldosterone Measurements in the Management of Arterial Hypertension

“…Renin levels were also the only parameter significantly predictive of response to each of the 4 drugs used (bisoprolol, losartan, hydrochlorothiazide, and amlodipine) in a recent randomized cross-over trial that investigated laboratory predictors of BP reduction [77]. On the contrary, another recent trial conducted in elderly ( > 70 years old) hypertensive patients failed to recognize an association between renin levels and BP response to valsartan and/or hydrochlorotiazide [78], whereas a recent observational study retrieved a significant association between renin levels and diastolic BP response and a trend towards an association between renin levels and systolic PB response [79]. On the whole, the studies so far presented reached conflicting conclusions about the predictive value of renin profiling: reasons for such an inconsistency have not been fully understood.…”

Influence of Age and Race on 24‐Hour Ambulatory Blood Pressure Responses to Valsartan, Hydrochlorothiazide, and Their Combination: Implications for Clinical Practice

“…6,7 It might be logical to assume that the variability in ARB responsiveness is parallel to the wide population variation in RAS activity; however, renin profiling has not generally proved useful in predicting sustained BP responses to RAS blockers. 8,9 Despite these variabilities and uncertainties, three recent guidelines have recommended that race and age should be important factors in hypertension management decisions: calcium channel blockers or diuretics (and not ACE inhibitors or ARBs) should be used as first-line agents in people of African descent and in patients older than 55 to 60 years. [10][11][12] All of these guidelines were touted as "evidence-based" yet no data were offered by the guideline groups to support such practices.…”

“…In older individuals, the effect of valsartan (VAL) on clinic systolic BP (SBP) was slightly less than that of hydrochlorothiazide (HCTZ), whereas there was no age effect on corresponding 24‐hour ambulatory BP values . It might be logical to assume that the variability in ARB responsiveness is parallel to the wide population variation in RAS activity; however, renin profiling has not generally proved useful in predicting sustained BP responses to RAS blockers …”