Abstract
Plasma renin activity (PRA)-guided therapy has been proposed as a strategy for selecting antihypertensive medications matched to the patient’s underlying pathophysiology. To date, there are only a few studies that have sought to compare a PRA-guided strategy to usual care. In one trial of 363 untreated patients, based on home blood pressure (BP) averages, PRA was predictive of responses to beta-blocker and thiazide diuretic as monotherapy and add-on therapy. In another trial of 77 treated but uncontrolled patients, a PRA-guided strategy was superior to clinical hypertension specialist care for guiding add-on or subtraction (stopping an agent that might cause a paradoxical pressor response) therapy. In the ValVET study, PRA-guided therapy was not superior to fixed-dose therapy consisting of an angiotensin receptor blocker and hydrochlorothiazide. One modeling study found a PRA-guided strategy may be cost-effective compared to standard care for younger patients and those with a greater number of cardiovascular risk factors. We conclude that additional, well-designed randomized trials with sufficient sample sizes comparing PRA-guided management to usual care are needed to clarify whether this strategy should be adopted broadly.
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Abbreviations
- ACE:
-
Angiotensin-converting enzyme
- BP:
-
Blood pressure
- CVD:
-
Cardiovascular disease
- HCTZ:
-
Hydrochlorothiazide
- JNC:
-
Joint National Commission
- PRA:
-
Plasma renin activity
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
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Acknowledgments
The authors wish to thank Jean Sealey, D.Sc., for her thoughtful review of this article.
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Anthony J. Viera and Curt D. Furberg declare that they have no conflicts of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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This article is part of the Topical Collection on Antihypertensive Agents: Mechanisms of Drug Action
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Viera, A.J., Furberg, C.D. Plasma Renin Testing to Guide Antihypertensive Therapy. Curr Hypertens Rep 17, 506 (2015). https://doi.org/10.1007/s11906-014-0506-0
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DOI: https://doi.org/10.1007/s11906-014-0506-0