Plasma renin activity, serum aldosterone concentration and selected organ damage indices in essential arterial hypertension

Abstract

Introduction The aim of this study was to assess the relations between plasma renin activity (PRA), serum aldosterone concentration (ALDO) and selected asymptomatic organ damage (AOD) indices in mild primary arterial hypertension (AH). Material and methods We measured PRA, ALDO, and selected AOD indices (carotid-femoral pulse wave velocity (cfPWV), central aortic pulse pressure (cPP), estimated glomerular filtration rate (eGFR)) in 122 patients with untreated AH. Results Patients with high PRA (≥ 0.65 ng/ml/h) were characterized by lower plasma sodium and aldosterone to renin ratio (ARR), higher ALDO, but a similar level of AOD indices compared to patients with low PRA. cfPWV ( p = 0.04) and cPP ( p = 0.019) increased with ARR, while eGFR decreased with ALDO ( p = 0.008). Only eGFR was independently correlated with ALDO. In subjects with simultaneously high PRA and ARR values, we found significantly higher cfPWV ( p = 0.02) and cPP ( p = 0.04) and lower eGFR ( p = 0.02) than in those with high PRA but low ARR values. Conclusions Assessment of the influence of the renin-angiotensin-aldosterone system (RAAS) on AOD should include the relationship between renin and aldosterone. The PRA itself has no predictive value for AOD. More advanced arterial stiffness and renal impairment are associated with increased PRA and ARR. The RAAS activity might be useful in AOD prediction and hypertension severity assessment.

Higher plasma renin activity is associated with increased kidney damage risk in patients with hypertension and glucose metabolic disorders

“…Several studies reported an association between PRA and kidney diseases in population of cardiovascular diseases with inconsistent results 12–14,24 . Our study suggests PRA as an independent predictor for future incident kidney damage, mainly for positive proteinuria, in hypertensive diabetic patients, who have higher risk for development of kidney disease.…”

“…Several studies reported an association between PRA and kidney diseases in population of cardiovascular diseases with inconsistent results. 12 , 13 , 14 , 24 Our study suggests PRA as an independent predictor for future incident kidney damage, mainly for positive proteinuria, in hypertensive diabetic patients, who have higher risk for development of kidney disease. The results are compatible with interventional studies that aliskiren showed renoprotection by decreasing proteinuria or albuminuria, whereas had no effects for serum creatinine or eGFR.…”

“… 29 , 30 Similarly, a recent study conducted in patients with essential hypertension using 0.65 as cut‐off value revealed that higher PRA (≥0.65), combined with high aldosterone‐to‐renin ratio (ARR), was associated with asymptomatic organ damage, such as higher carotid‐femoral pulse wave velocity, central aortic pulse pressure, and lower estimated glomerular filtration rate. 24 Results from the SPYRAL HTN‐OFF MED Pivotal trial also showed a different therapeutic response between high (PRA ≥0.65) and low (PRA < 0.65) groups, with a significant greater decrease in 24‐hour and office systolic blood pressure after renal denervation for high PRA group. 22 In addition, a recent randomized controlled trial demonstrated that aliskiren restores endothelial function and induces a more prompt peripheral vasodilation in hypertensive and diabetic patients.…”

“…PRA was log‐transformed (log‐PRA) due to skewed distribution, and was also dichotomized as high‐renin (PRA ≥.65) or low‐renin (PRA < 0.65) groups according to Laragh and Alderman criteria. 22 , 23 , 24 Hazard ratios (HR) for outcomes were calculated for each SD increment in log‐PRA and for high‐renin group (vs. low‐renin group). It has been reported that subnormal PRA (< 0.65) indicated sodium‐volume excess “V” hypertension, whereas values ≥0.65 indicated renin‐angiotensin vasoconstriction excess “R” hypertension, 25 suggesting potential differences of pathophysiological mechanism.…”

Pemeriksaan Aldosterone/Renin Ratio Sebagai Prediktor Penyakit Ginjal Kronis Pada Penderita Hipertensi

“…Jalur fisiologis RAAS bersifat esensial dalam menjaga kondisi normotensi, vasokonstriksi, serta retensi volume darah. 2,5 Selama ini, aldosterone-to-renin ratio (ARR) dipercaya sebagai parameter pemeriksaan screening yang kuat dibandingkan pengukuran kadar aldosterone untuk kondisi primary aldosteronism (PA). ARR dapat menjadi indeks aktivitas aldosterone serta peningkatan sensitivitas terhadap garam.…”