Interpreting stimulated plasma renin and aldosterone to select physiologically individualized therapy for resistant hypertension: importance of the class of stimulating drugs

被引:10
作者
Huang, Xiao [1 ]
Li, Junpei [1 ]
Liu, Lishun [2 ]
Chen, Guangliang [3 ]
Yi, Yingping [4 ]
Li, Ping [1 ]
Wu, Yanqing [1 ]
Xu, Yuan [4 ]
Bao, Huihui [1 ]
Yu, Lianbao [5 ]
Qin, Xianhui [6 ]
Zhang, Yan [7 ]
Wang, Binyan [8 ]
Li, Jianping [7 ]
Hou, Fan Fan [6 ]
Huo, Yong [7 ]
Cheng, Xiaoshu [1 ]
Spence, J. David [9 ]
机构
[1] Nanchang Univ, Affiliated Hosp 2, Dept Cardiol, Nanchang, Jiangxi, Peoples R China
[2] China Agr Univ, Coll Food Sci & Nutr Engn, Adv Innovat Ctr Food Nutr & Human Hlth, Beijing, Peoples R China
[3] Anhui Univ Chinese Med, Coll Integrated Chinese & Western Med, Hefei, Anhui, Peoples R China
[4] Nanchang Univ, Affiliated Hosp 2, Med Big Data Ctr, Nanchang, Jiangxi, Peoples R China
[5] Qinghua Town Hlth Ctr, Wuyuan, Peoples R China
[6] Southern Med Univ, Natl Clin Res Study Ctr Kidney Dis, State Key Lab Organ Failure Res, Renal Div,Nanfang Hosp, Guangzhou, Guangdong, Peoples R China
[7] Peking Univ, Dept Cardiol, Hosp 1, Beijing, Peoples R China
[8] Anhui Med Univ, Inst Biomed, Hefei, Anhui, Peoples R China
[9] Western Univ, Robarts Res Inst, Stroke Prevent & Atherosclerosis Res Ctr, London, ON, Canada
基金
中国国家自然科学基金;
关键词
Aldosterone; Antihypertensive drug class; Personalized medicine; Renin; Stimulation; UNCONTROLLED HYPERTENSION; ANGIOTENSIN; ENAC;
D O I
10.1038/s41440-019-0327-2
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
In the treatment of resistant hypertension, physiologically individualized therapy based on phenotyping with plasma renin activity (PRA) and plasma aldosterone significantly improves blood pressure control. Patients with a low-renin/low aldosterone (Liddle) phenotype respond best to amiloride, while those with low-renin/high aldosterone respond best to aldosterone antagonists, and those with high renin/high aldosterone (renal phenotype) respond best to angiotensin receptor blockers (ARB). However, it is important to measure PRA in a stimulated condition to distinguish between low levels due to high salt intake, licorice or nonsteroidal inflammatory drugs and low levels due to suppression by excess aldosterone secretion or renal tubular genetic variants causing retention of salt and water (Liddle phenotype). In the past, both diuretics and angiotensin converting inhibitors (ACEi) have been used for this purpose, and it has been assumed that these classes of drugs are equivalent. In this study of 2896 patients with hypertension, we evaluated that assumption. We found important differences among diuretics alone, ACEi/ARB alone, and ACEi/ARB + diuretics, which all stimulated PRA. However, ACEi/ARB lowers plasma aldosterone, and beta blockers lower PRA. Among patients with systolic pressure >= 180 mmHg +/- diastolic pressure >= 100 mmHg stimulated only by diuretics, the phenotypes were 25% Liddle, 38% IA, 8.7% renal, and 28.3% mixed. In choosing physiologically individualized therapy based on PRA and aldosterone, it is important to consider the classes of stimulating drugs. Phenotypes are best distinguished by taking into account the aldosterone/PRA ratio in addition to the levels of PRA and aldosterone.
引用
收藏
页码:1971 / 1978
页数:8
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