Low renin activity and blood pressure management

Abstract

Clinical outcomes in patients with LRH referred to a hypertension program are unknown. To determine blood pressure (BP) outcomes in patients with LRH, we examined the records of a single practitioner (RRT) outpatient hypertension program at a University hospital, using a preset survey tool. Seated renin activity is routinely performed in new referrals to our program since 1998. Preliminary data included 43 subjects: age 59 years±12 (Mean ± SD), 56 % female, 33 % white, 23 % AA and 14 % diabetic. Mean renin activity was 1.6 ± 2.2 ng/ml/hr. Twenty-nine (67%) patients with renin< 1.0 were designated as LRH and the remaining 14 (33%) were designated as non-LRH. There were no differences in demographics between LRH and non-LRH patients. The seated BP in the dominant arm at the first visit (average of 2 readings) was 153±46 mm Hg. At final visit 20 (69) % of LRH and 12 (86 %) of non-LRH achieved a systolic BP < 140 mm Hg (p= 0.238). The time to achieve this blood pressure control was longer in the LRH patients than in the non-LRH patients (140 vs 77 days, Hazard Ratio= 1.14, p=0.8). Patients took 2.7 ± 1.7 medications prior to the first visit and 3.0 ± 1.7 medications at their final visit (p=0.12). There were no significant differences in number of medicines required by the LRH versus the non-LRH patients. The table below shows the number of patients taking each class of indicated medication “prior” to the first visit, compared with their medication profile at their “final” visit. Statistically significant drug maneuvers used to reach blood pressure control in the LRH patients included: increase in use of Thiazides, K-sparing diuretics and dihydropyridine calcium channel blockers (CCB-D). In the non-LRH patients, the usage of dihydropyridine CCBs was increased. There was no stastically significant difference in type of drugs used at final visit between the LRH and non-LRH groups. Significant Drug Changes in LRH and non-LRH Patients =p < 0.05 comparing prior to final visit drug usage. Significant Drug Changes in LRH and non-LRH Patients =p < 0.05 comparing prior to final visit drug usage. LRH is common in patients referred to a hypertension program. BP control can be achieved in the LRH group with increased use of diuretics and CCB. BP control in both LRH and non-LRH patients can be achieved without a substantial increase in average number of medicines through use of combination drug products.