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The renin-angiotensin system in blacks: Active, passive, or what?

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Abstract

Plasma renin activity in blacks has been consistently reported to be lower than in whites. Many mechanisms for the low plasma renin activity have been proposed, including volume status, renal sodium handling, and the reduction of renin release. The status of the RAS is paramount in the regulation of salt and water balance and its implications in disease processes such as hypertension and renal failure. In this review, we present data to suggest that low systemic plasma renin activity in blacks may not be the primary abnormality, but rather the reflection of an overactive RAS at the tissue level in the kidney.

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References and Recommended Reading

  1. Helmer OM, Judson WE: Metabolic studies on hypertensive patients with suppressed plasma renin activity not due to hyperaldosternosm. Circulation 1968, 38:965–976.

    PubMed  CAS  Google Scholar 

  2. Gillum RF, Mussolino ME, Madans JH: Coronary heart disease incidence and survival in African-American women and women. The NHANES I Epidemiologic Follow-up Study. Ann Intern Med 1997, 127:111–118.

    PubMed  CAS  Google Scholar 

  3. Anderson NB, Myers HF, Pickering T, Jackson JS: Hypertension in blacks: psychosocial and biological perspectives. J Hypertens 1989, 7:161–172.

    PubMed  CAS  Google Scholar 

  4. Kaplan NM, Kem DC, Holland OB, et al.: The intravenous furosemide test: a simple way to evaluate renin responsiveness. Ann Intern Med 1976, 84:639–645.

    PubMed  CAS  Google Scholar 

  5. Levy SB, Lilley JJ, Frigon RP, Stone RA: Urinary kallikrein and plasma renin activity as determinants of renal blood flow. The influence of race and dietary sodium intake. J Clin Invest 1977, 60:129–138.

    PubMed  CAS  Google Scholar 

  6. Luft FC, Weinberger MH, Grim CE: Sodium sensitivity and resistance in normotensive humans. Am J Med 1982, 72:726–736.

    Article  PubMed  CAS  Google Scholar 

  7. Hohn AR, Riopel DA, Keil JE, et al.: Childhood familial and racial differences in physiologic and biochemical factors related to hypertension. Hypertension 1983, 5:56–70.

    PubMed  CAS  Google Scholar 

  8. Price DA, Fisher NDL, Lansang MC, et al.: Renal perfusion in blacks, alterations caused by insuppressibility of intrarenal renin with salt. Hypertension 2002, 40:186–189.

    Article  PubMed  CAS  Google Scholar 

  9. Price DA, Fisher NDL, Osei SY, et al.: Renal perfusion and function in healthy African Americans. Kidney Int 2001, 59:1037–1043.

    Article  PubMed  CAS  Google Scholar 

  10. Sagnella GA: Why is plasma renin activity lower in populations of African origin? J Hum Hypertens 2001, 15:17–25.

    Article  PubMed  CAS  Google Scholar 

  11. James GD, Sealey JE, Muller F, et al.: Renin relationship to sex, race and age in a normotensive population. J Hypertens Suppl 1986, 4:S387-S389.

    Article  PubMed  CAS  Google Scholar 

  12. Brunner HR, Sealey JE, Laragh JH: Renin as a risk factor in essential hypertension: more evidence. Am J Med 1973, 55:295–302.

    Article  PubMed  CAS  Google Scholar 

  13. He J, Klag MJ, Appel LJ, et al.: The renin-angiotensin system and blood pressure: differences between blacks and whites. Am J Hypertens 1999, 12:555–562.

    Article  PubMed  CAS  Google Scholar 

  14. Bloem LJ, Manatunga AK, Tewksbury DA, Pratt JH: The serum angiotensinogen concentration and variants of the angiotensinogen gene in white and black children. J Clin Invest 1995, 95:948–953.

    Article  PubMed  CAS  Google Scholar 

  15. Gomez-Sanchez CE, Holland OB: Urinary tetrahydroaldosterone and aldosterone-18 glucuronide excretion in white and black normal subjects and hypertensive patients. J Clin Endocrinol Metab 1981, 52:214–219.

    Article  PubMed  CAS  Google Scholar 

  16. Pratt JH, Rebhun JF, Zhou L, et al.: Levels of mineralocorticoids in whites and blacks.

  17. Fisher NDL, Gleason RE, Moore TJ, et al.: Regulation of aldosterone secretion in hypertensive blacks. Hypertension 1994, 23:179–184.

    PubMed  CAS  Google Scholar 

  18. Grim CE, Luft FC, Miller JZ, et al.: Racial differences in blood pressure in Evans County, Georgia: relationship to sodium and potassium intake and plasma renin activity. J Chron Dis 1980, 33:87–94.

    Article  PubMed  CAS  Google Scholar 

  19. Langford HG, Cushman WC, Hsu H: Chronic effect of KCl on black-white differences in plasma renin activity, aldosterone, and urinary electrolytes. Am J Hypertens 1991, 4:399–403.

    PubMed  CAS  Google Scholar 

  20. Gillum RF: Pathophysiology of hypertension in blacks and whites. A review of the basis of racial blood pressure differences. Hypertension 1979, 1:468–475.

    PubMed  CAS  Google Scholar 

  21. Wedler B, Brier ME, Wiersbitzky M, et al.: Sodium kinetics in salt-sensitive and salt resistant normotensive and hypertensive subjects. J Hypertens 1992, 10:663–669.

    Article  PubMed  CAS  Google Scholar 

  22. Luft FC, Grim CE, Higgins JT, Weinberger MH: Differences in response to sodium administration in normotensive white and black subjects. J Lab Clin Med 1977, 90:555–562.

    PubMed  CAS  Google Scholar 

  23. Brier ME, Luft FC: Sodium kinetics in white and black normotensive subjects: possible relevance to salt-sensitive hypertension. Am J Med Sci 1994, 307(Suppl 1):S38-S42.

    PubMed  Google Scholar 

  24. Sowers JR, Zemel MB, Zemel P, et al.: Salt sensitivity in blacks, salt intake and natriuretic substances. Hypertension 1988, 12:485–490.

    PubMed  CAS  Google Scholar 

  25. Grim CE, Henry JP, Myers H: High blood pressure in blacks: salt, slavery, survival, stress, and racism. In Hypertension: Pathophysiology, Diagnosis, and Management. Edited by Laragh JH, Brenner BM. New York: Raven Press, Ltd; 1995:185.

    Google Scholar 

  26. Trujillo A, Eggena P, Barrett J, Tuck M: Renin regulation in type 2 diabetes mellitus: Influence of dietary sodium. Hypertension 1989, 13:200–205.

    PubMed  CAS  Google Scholar 

  27. Christlieb AR, Kaldany A, D’Elia JA: Plasma renin activity and hypertension in diabetes mellitus. Diabetes 1976, 25:969–974.

    Article  PubMed  CAS  Google Scholar 

  28. Bjork S: the renin-angiotensin system in diabetes mellitus: A physiological and therapeutic study. Scand J Urol Nephrol Suppl 1990, 126:1–50.

    Google Scholar 

  29. Lush DJ, King JA, Fray JCS: Pathophysiology of low renin syndromes: Sites of renal renin secretory impairment and prorenin overexpression. Kidney Int 1993, 43:983–999.

    PubMed  CAS  Google Scholar 

  30. Weidmann P, Ferrari P, Shaw SG: Renin in diabetes mellitus. In The Renin-Angiotensin System. Edited by Robertson JIS, Nicholls MG. New York: Raven Press; 1991:75.1–75.26.

    Google Scholar 

  31. Price DA, Porter LE, Gordon M, et al.: The paradox of the lowrenin state in diabetic nephropathy. J Am Soc Nephrol 1999, 10:2382–2391.

    PubMed  CAS  Google Scholar 

  32. Rosenberg ME, Smith LJ, Correa-Rotter R, Hostetter TH: The paradox of the renin-angiotensin system. Kidney Int 1994, 45:403–410.

    PubMed  CAS  Google Scholar 

  33. Anderson S, Jung FF, Ingelfinger JR: Renal renin-angiotensin system in diabetes: functional immunohistochemical, and molecular biological correlation. Am J Physiol 1993, 265:F477-F486.

    PubMed  CAS  Google Scholar 

  34. Vallon V, Wead LM, Blantz RC: Renal hemodynamics and plasma and kidney angiotensin II in established diabetes mellitus in rats: Effect of sodium and salt restriction. J Am Soc Nephrol 1995, 5:1761–1767.

    PubMed  CAS  Google Scholar 

  35. Lewis EJ, Hunsicker LG, Bain RP, Rodhe RD: The effect of angiotensin-converting enzyme inhibition on diabetic nephropathy. N Engl J Med 1993, 329:1456–1462.

    Article  PubMed  CAS  Google Scholar 

  36. Brenner BM, Cooper ME, e Zeeuw DM, et al.: Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001, 345:861–869. This article demonstrates that interruption of the renin system with the angiotensin receptor blocker, losartan, in type 2 diabetic patients with nephropathy confers significant renal benefit.

    Article  PubMed  CAS  Google Scholar 

  37. Parving HH, Lehnert H, Brochner-Mortensen J, et al.: The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001, 345:870–878. This paper shows the renoprotective effect of the angiotensin receptor blocker, irbesartan, in type 2 diabetic patients with nephropathy is independent of its blood pressure-lowering effect. A dose response was also seen in the renoprotective effect of reducing microalbuminuria.

    Article  PubMed  CAS  Google Scholar 

  38. Rotimi C, Puras A, Cooper R, McFarlane-Anderson N, et al.: Polymorphisms of renin-angiotensin genes among Nigerians, Jamaicans, and African Americans. Hypertension 1996, 27:558–563.

    PubMed  CAS  Google Scholar 

  39. Rotimi C, Cooper R, Ogunbiyi O, et al.: Hypertension, serum angiotensinogen, and molecular variants of the angiotensinogen gene among Nigerians. Circulation 1997, 95:2348–2350.

    PubMed  CAS  Google Scholar 

  40. Forrester T, McFarlane-Anderson N, Bennet F, et al.: Angiotensinogen and blood pressure among blacks: findings from a community survey in Jamaica. J Hypertens 1996, 14:315–321.

    Article  PubMed  CAS  Google Scholar 

  41. US Renal Data System: USRDS 2000 Annual Data Report. Bethesda: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIH)DHHS; 2000.

    Google Scholar 

  42. Agodoa LY, Jones CA, Held PJ: End-stage renal disease in the USA: data from the United States renal Data System. Am J Nephrol 1996, 16:7–16.

    Article  PubMed  CAS  Google Scholar 

  43. Rosansky SJ, Hoover DR, King L, Gibson J: The association of blood pressure levels and change in renal function in hypertensive and nonhypertensive subjects. Arch Intern Med 1990, 150:2073–2076.

    Article  PubMed  CAS  Google Scholar 

  44. Brazy PC, Fitzwilliams JF: Progressive renal disease: role of race and antihypertensive medications. Kidney Int 1990, 37:1113–1119.

    PubMed  CAS  Google Scholar 

  45. Agodoa LY, Appel L, Bakris GL, et al.: Effect of rampril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: a randomized controlled trial. JAMA 2001, 285:2719–2728. This study shows that the use of the ACE inhibitor ramipril slows progression of hypertensive renal disease in blacks compared with the dihydropyridine calcium channel blocker amlodipine. This landmark study in blacks with renal insufficiency also proves that the use of ACE inhibition can attain target blood pressure control when used with additional antihypertensive medication, diuretics being the most widely used.

    Article  PubMed  CAS  Google Scholar 

  46. Jamerson KA: Rationale for angiotensin II receptor blockers in patients with low-renin hypertension. Am J Kidney Dis 2000, 36(Suppl 1):S24-S30. This review article gives rationale for the use of blockers to the RAS in low-renin groups such as blacks.

    PubMed  CAS  Google Scholar 

  47. Materson BJ, Reda DJ, Cushman WC, et al.: Single-drug therapy for hypertension in men: a comparison of 6 antihypertensive agents with placebo. N Engl J Med 1993, 328:914–921.

    Article  PubMed  CAS  Google Scholar 

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Price, D.A., Fisher, N.D.L. The renin-angiotensin system in blacks: Active, passive, or what?. Current Science Inc 5, 225–230 (2003). https://doi.org/10.1007/s11906-003-0025-x

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