Abstract
Plasma renin activity (PRA) levels have been used to define two categories of essential hypertensive patients differing for the basic pathophysiological mechanisms sustaining high blood pressure and for the responsiveness to different antihypertensive agents. In particular, patients with low-renin hypertension should respond better to antisodium-volume drugs and patients with normal- to high-renin hypertension should respond better to renin angiotensin aldosterone system-targeted drugs. Although the experimental verification of this treatment algorithm in both retrospective and prospective analyses of several clinical trials has led to mixed results, the recommendations from the British Hypertension Society can be interpreted in the light of this approach by substituting the direct determination of PRA with the use of demographic parameters (such as race and age), which have been demonstrated to be strictly correlated to PRA levels. Furthermore, the use of PRA screening has also been advocated in cases of resistant hypertension.
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