Essential Hypertension: Renin and Aldosterone, Heart Attack and Stroke

TLDR

The study proposes plasma renin activity as a risk factor in essential hypertension to guide etiology, prognosis, and therapy. The authors measured aldosterone excretion and plasma renin activity in 219 hypertensive patients and compared them to a sodium‑balance nomogram derived from 52 healthy volunteers. Among the cohort, 27 % had low, 57 % normal, and 16 % high renin; patients with normal or high renin experienced heart attacks or strokes in 11–14 % of cases, whereas none of the 59 low‑renin patients did, suggesting low renin confers protection despite comparable hypertension and left‑ventricular enlargement.

Abstract

Abstract In 219 patients with essential hypertension, aldosterone excretion and plasma renin activity were related to daily sodium excretion and compared to a nomogram drawn from 52 normal volunteers studied over the same continuous range of sodium balance. Plasma renin activity was subnormal in 27 per cent, normal in 57 per cent and elevated in 16 per cent. Further study showed eight patterns of renin and aldosterone secretion. Patients with normal or high renin had an 11 and 14 per cent frequency respectively of heart attacks or strokes. However, during a similar period of observation, none of 59 low renin patients had any of these complications. They appear protected despite similar hypertension, similar left ventricular enlargement, and despite higher mean age. Plasma renin activity emerges as a potential risk factor for patients with essential hypertension — useful for identifying etiologies, determining prognosis and applying therapy.