Role of Renin Classification for Diuretic Treatment of Black Hypertensive Patients

Holland, O. B.; Gómez-Sánchez, Celso E.; Fairchild, Carol; Kaplan, Norman M.

doi:10.1001/archinte.1979.03630490029011

Cited by 26 publications

(6 citation statements)

References 27 publications

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“…Therefore, renin profiling was used to predict the response to hydrochlorothiazide in six papers, 25 mg/d in 363 participants (152 of African ancestry), of the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR) study; [15] 12.5 to 50 mg/d in a Veterans Administration study in 335 subjects (152 of African ancestry); [38] 50 mg/d in 83 patients of African ancestry; [57] 50 to 200 mg/d in 212 participants (129 of African ancestry) in another Veterans Administration study; [63] 100 mg/d in 61 patients of African ancestry; [65] and 100 mg/d (vs furosemide 80 mg/d) in 29 patients of African ancestry [66]. …”

Section: Resultsmentioning

confidence: 99%

“…Renin did not predict the response to hydrochlorothiazide monotherapy in four studies [57,63,65,66], nor to furosemide (80 mg/d) [66], or spironolactone 100 to 400 mg/d [65]. In the PEAR study, the β ± SE for prediction of systolic blood pressure with renin was 1.87 ± 0.90 ( P = 0.04), with a relative contribution of African ancestry of −2.12 ± 1.47 ( P = 0.15); [15] and regression models that included ancestry and age explained similar [15] or greater [38] variation in blood pressure response than renin.…”

Section: Resultsmentioning

confidence: 99%

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Why do hypertensive patients of African ancestry respond better to calciumblockers and diuretics than to ACE inhibitors and β-adrenergic blockers? Asystematic review

Brewster

Seedat

2013

BMC Med

115

134

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BackgroundClinicians are encouraged to take an individualized approach when treating hypertension in patients of African ancestry, but little is known about why the individual patient may respond well to calcium blockers and diuretics, but generally has an attenuated response to drugs inhibiting the renin-angiotensin system and to β-adrenergic blockers. Therefore, we systematically reviewed the factors associated with the differential drug response of patients of African ancestry to antihypertensive drug therapy.MethodsUsing the methodology of the systematic reviews narrative synthesis approach, we sought for published or unpublished studies that could explain the differential clinical efficacy of antihypertensive drugs in patients of African ancestry. PUBMED, EMBASE, LILACS, African Index Medicus and the Food and Drug Administration and European Medicines Agency databases were searched without language restriction from their inception through June 2012.ResultsWe retrieved 3,763 papers, and included 72 reports that mainly considered the 4 major classes of antihypertensive drugs, calcium blockers, diuretics, drugs that interfere with the renin-angiotensin system and β-adrenergic blockers. Pharmacokinetics, plasma renin and genetic polymorphisms did not well predict the response of patients of African ancestry to antihypertensive drugs. An emerging view that low nitric oxide and high creatine kinase may explain individual responses to antihypertensive drugs unites previous observations, but currently clinical data are very limited.ConclusionAvailable data are inconclusive regarding why patients of African ancestry display the typical response to antihypertensive drugs. In lieu of biochemical or pharmacogenomic parameters, self-defined African ancestry seems the best available predictor of individual responses to antihypertensive drugs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Why do hypertensive patients of African ancestry respond better to calciumblockers and diuretics than to ACE inhibitors and β-adrenergic blockers? Asystematic review

Brewster

Seedat

2013

BMC Med

115

134

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“…However, more direct investigations of pre-treatment renin status in hypertensive blacks in relation to blood pressure response have demonstrated that the pretreatment PRA was not a particularly effective index of subsequent blood pressure response to pharmacological treatment. 24,[86][87][88][89] Nevertheless, other studies have demonstrated that the blood pressure reduction to short term sodium restriction was greater in blacks compared with whites; moreover, in the blacks, the greater reduction in blood pressure was significantly related, at least in part, to the decreased responsiveness of the renin-angiotensin system. 12 …”

Section: Functional Significance Of Lower Pra In Blacksmentioning

confidence: 99%

Why is plasma renin activity lower in populations of African origin?

Sagnella

2000

J Hum Hypertens

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Plasma renin activity is significantly lower in black people compared with whites independent of age and blood pressure status. The lower PRA appears to be due to a reduction in the rate of secretion of renin but the exact mechanistic events underlying such differences in renin release between blacks and whites are still not fully understood. Nevertheless, given the paramount importance of the renin-angiotensin system in the control of sodium balance, a most likely explanation is that the lower renin is a consequence of differences in renal sodium handling between blacks and whites. The lower PRA does not reflect differences in dietary sodium intake but the evidence available suggests that the low PRA could be part of the corrective mechanisms designed to maintain sodium balance in the presence of an increased tendency for sodium retention in black people. While it is possible that several factors may contribute to the reduced PRA, more recent investigation at

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“…Renin classification was initially performed with plasma renin activity (PRA) response to 2 h of ambulation (13) or with the intravenous furosemide test (14). Those patients who appeared to have low-renin hypertension after this testing were evaluated further by determining supine and ambulatory PRA after receiving a 10-meq sodium diet for 6 d2 or by determining ambulatory PRA after diuretic administration (13) after ACTH administration in the initial eight patients studied to determine the optimal time of blood sampling. PA usually was slightly higher in the 15-min sample, whereas plasma cortisol was essentially the same in both (Table II).…”

Section: Methodsmentioning

confidence: 99%

Aldosterone suppression with dopamine infusion in low-renin hypertension.

et al. 1983

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A B S T R A C T A dopaminergic mechanism has been proposed to suppress aldosterone secretion. To assess the possibility that a defect in the dopaminergic mechanism might enhance aldosterone secretion in hypertensive patients, we determined basal and adrenocorticotropic hormone (ACTH)-stimulated plasma aldosterone (PA), cortisol, renin activity, and potassium concentrations before and during dopamine receptor stimulation with dopamine infusion and bromocriptine administration and dopamine receptor blockade with metoclopramide. The patient study groups included: (a) seven patients with low-renin hypertension and abnormal aldosterone suppression with sodium loading and presumed bilateral zona glomerulosa hyperplasia (ZGHP); (b) two patients with aldosterone-producing adenoma; (c) five patients with low-renin hypertension but normal aldosterone suppression with sodium loading; and (d) six patients with normal-renin hypertension.Dopamine infusion in patients with ZGHP caused PA to fall (P < 0.01) into the normal range, but did not block the enhanced (P < 0.05) aldosterone response to ACTH that is characteristic of these patients. Dopamine infusion in patients with low-renin hypertension but normal aldosterone suppression also suppressed PA (P < 0.01), whereas it had no effect upon PA in patients with normal-renin hypertension or aldosterone-producing adenoma and did not blunt the

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Role of Renin Classification for Diuretic Treatment of Black Hypertensive Patients

Cited by 26 publications

References 27 publications

Why do hypertensive patients of African ancestry respond better to calciumblockers and diuretics than to ACE inhibitors and β-adrenergic blockers? Asystematic review

Why do hypertensive patients of African ancestry respond better to calciumblockers and diuretics than to ACE inhibitors and β-adrenergic blockers? Asystematic review

Why is plasma renin activity lower in populations of African origin?

Aldosterone suppression with dopamine infusion in low-renin hypertension.

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