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John H Laragh - One of the best experts on this subject based on the ideXlab platform.

  • Plasma Renin Activity pra levels and antihypertensive drug use in a large healthcare system
    American Journal of Hypertension, 2012
    Co-Authors: Simran K Bhandari, Scott A Rasgon, Jean E Sealey, Kamyar Kalantarzadeh, John H Laragh
    Abstract:

    BACKGROUND: Although hypertension guidelines have utility in treating uncomplicated hypertension, they often overlook the pathophysiologic basis and heterogeneity of hypertension. This may explain the relatively poor hypertension control rates. A proposed approach is to guide addition and subtraction of medications using ambulatory Plasma Renin Activity (PRA) values. To evaluate the heterogeneity of hypertension and the medication burden associated with it, we investigated medication usage in relation to PRA among hypertensive patients within a large ethnically diverse organization. METHODS: A cross sectional data analysis was performed of hypertensive subjects with PRA measurements in the Kaiser Permanente Southern California database between 1 January 1998 and 31 October 2009. RESULTS: Among 7,887 such patients 0, 1, 2, ≥3 medication usage was 16%, 20%, 24%, 40% respectively. PRA levels ranged 1000-fold. Across PRA quartiles (Q1 to Q4) ≥3 meds were prescribed to 50%, 40%, 34%, 37%. From low to high PRA quartiles there was no usage trend for angiotensin converting enzyme inhibitors (ACEIs)/ angiotensin receptor blockers (ARBs) (71%), but diuretics increased (52%, 53%, 57%, 68%), calcium channel blocker's (CCB) fell (56%, 53%, 51%, 42%), and β-blockers fell (77%, 61%, 49%, 41%). Moreover, systolic BP fell (146, 142, 140, 135 mm Hg), blood urea nitrogen (BUN) rose (16, 17, 18, 20 mg/dl), serum uric acid rose (6.1, 6.3, 6.5, 6.9 mg/dl), and chronic kidney disease rose (22%, 22%, 23%, 27%). CONCLUSIONS: Polytherapy was the norm for treating hypertension. Lower PRAs were associated with higher blood pressures and more medications. Higher PRAs were associated with lower pressures and fewer medications. The results indicate that opportunities exist to simplify antihypertensive therapy by using current ambulatory PRA levels to guide drug selections and subtractions.

  • enduring direct association of baseline Plasma Renin Activity with all cause and cardiovascular mortality in hypertensive patients
    American Journal of Hypertension, 2011
    Co-Authors: Maday C Gonzalez, John H Laragh, Hillel W Cohen, Jean E Sealey, Michael H Alderman
    Abstract:

    Background Plasma Renin Activity (PRA) has been associated with cardiovascular disease mortality (CVD) events among hypertensive patients. We now report a long-term follow-up to assess the enduring association of PRA to CVD and all-cause mortality. methodS Participants (3,791) in a systematic hypertension treatment study had entry systolic blood pressure (BP) ≥140 mm Hg and mean age 52. CVD and all-cause mortality was ascertained for mean of 16 years. Pretreatment PRA was analyzed as a continuous variable, and by tertiles. The 10-year Framingham score was similarly examined. Hazard ratios (HRs) were estimated from multivariate Cox proportional hazard models. reSult S There were 804 deaths, and 360 (45%) were CVD. PRA was associated with all-cause mortality and CVD, but not cancer or non-CVD. Although T3 had lower mean baseline and follow-up systolic BP than T1, (146 vs. 152 mm Hg (P < 0.001) and 135 vs. 139 mm Hg (P < 0.001), respectively), T3 had 37% higher all-cause mortality (HR: 1.37, 95% confidence interval (CI): 1.15–1.63, P < 0.001) and 70% higher CVD mortality (HR: 1.70, 95% CI: 1.29–2.23, P < 0.001) after adjustment. The difference between T3 and T1 in mortality from coronary artery disease and myocardial infarction was more pronounced than for all CVD. PRA also significantly improved CVD risk estimation provided by Framingham. concluSionS These findings extend and reinforce previous evidence that pretreatment PRA has a significant, independent, specific, and direct long-term association with CVD mortality. Moreover, PRA adds significantly to risk identified by the Framingham score.

  • Plasma Renin Activity enzyme kinetic assay protection of angiotensin i from bacterial degradation
    Clinical Chemistry, 2011
    Co-Authors: Jean E Sealey, John H Laragh
    Abstract:

    To the Editor: Bystrom et al. (1) recently reported substantial peptidase Activity in human Plasma that had been incubated at 37 °C to generate angiotensin I (Ang I)1 during the clinical Plasma Renin Activity (PRA) assay. If this result is correct, it would call into question many of the PRA results previously reported by our laboratory and by Quest Diagnostics, especially those with low PRA (<0.65 μg · L− · h−). We believe, however, this observation is most likely an artifact caused by a failure to follow published protocols (2, 3). Several features of the Ang I degradation reported by …

  • effective Plasma Renin Activity a derived measure for assessing residual Plasma Renin Activity in patients taking angiotensin converting enzyme inhibitors or angiotensin receptor blockers
    Hypertension, 2010
    Co-Authors: Jean E Sealey, David Parra, Robert S Rosenstein, John H Laragh
    Abstract:

    To the Editor: The Plasma Renin Activity (PRA) test quantifies the circulating Activity of the Renin-angiotensin system by measuring the rate at which Renin forms angiotensin I (Ang I) in Plasma. The PRA test overestimates the true Activity of the circulating Renin-angiotensin system in patients taking angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) because these drugs block the system at sites distal to the enzymatic release of Ang I by Plasma Renin.1,2 When patients are taking these drugs, a simple calculation can be used to determine …

  • Plasma Renin Activity a risk factor for myocardial infarction in hypertensive patients
    American Journal of Hypertension, 1997
    Co-Authors: Michael H Alderman, Wee Lock Ooi, Hillel W Cohen, Shantha Madhavan, Jean E Sealey, John H Laragh
    Abstract:

    To determine whether pretreatment Plasma Renin Activity (PRA), without accompanying 24-h urine sodium, can predict myocardial infarction (MI), the PRA levels of 2,902 hypertensive patients [white (38%), male (65%), median age 55 years], with mean entry blood pressure (BP) of 150/97 mm Hg were examined. During an average 3.6 years follow-up (87% > or = 9 months), there were 55 MIs, 21 strokes, and 16 other cardiovascular disease (CVD) deaths. Classification of PRA levels into 3 Renin strata [high (H) PRA > or = 4.5 (n = 354), normal (N) 0.75 to 4.49 (n = 1,622), and low (L) or = 6.3 mmol/L (33% v 25%); all P values < .01. MI rates per 1,000/year were H: 9.3, N: 5.5, L: 2.5 (H v L, RR = 3.8, 95% CI: 1.7 to 8.4). A similar relationship was seen with total CVD (H: 12.5, N: 9.3, L: 5.2; RR = 2.4, 95% CI: 1.3 to 4.5) and all-cause mortality (H: 7.0, N: 6.2, L: 2.5; RR = 2.8, 95% CI: 1.2 to 6.8) but not CVA (H: 1.6, N: 2.0, L: 1.9). In a Cox survival analysis only Renin, age, sex, smoking, LVH, and cholesterol were significantly (P < .02) related to MI occurrence. There was, for every 2 unit increase in PRA, an overall 25% increase in MI incidence. Among hypertensive subjects, PRA level (without urine sodium), is independently and directly associated with the incidence of MI.

Jeffrey L Anderson - One of the best experts on this subject based on the ideXlab platform.

  • abstract 12842 both hyponatremia and elevated Plasma Renin Activity are independent and additive cardiovascular risk factors in patients with angiographically proven coronary artery disease cad the intermountain heart collaborative study
    Circulation, 2014
    Co-Authors: Tami L Bair, Jeffrey L Anderson, Benjamin D Horne, Joseph B Muhlestein
    Abstract:

    Background: Several studies have documented an increased risk of future major adverse cardiovascular events (MACE) among CAD patients with elevated baseline Plasma Renin Activity (PRA). One of the proposed mechanisms of elevated PRA is sodium depletion - hyponatremia. However, the relationship between PRA and hyponatremia is not well defined. Methods: A total of 1,781 pts with angiographic CAD (>50% stenosis) enrolled in the Intermountain Heart Collaborative Study were evaluated. Pts were excluded if they had a history of myocardial infarction (MI), heart failure (HF), left ventricular ejection fraction (EF) 2.3 ng/ml/h) and low (≤2.3 ng/ml/h) risk categories. The independent associations between these categories and MACE (death, MI, HF hospitalization, stroke and new onset renal failure) at five years were determined by multivariable Cox hazard...

  • relation of elevated Plasma Renin Activity at baseline to cardiac events in patients with angiographically proven coronary artery disease
    American Journal of Cardiology, 2010
    Co-Authors: Tami L Bair, Jeffrey L Anderson, Benjamin D Horne, Joseph B Muhlestein, Heidi T May, Margaret F Prescott, Richard H White
    Abstract:

    Plasma Renin Activity (PRA) is a measure of Renin-angiotensin system Activity and is associated with cardiovascular outcomes in patients with heart failure (HF). We conducted a prospective analysis to assess whether elevated baseline PRA is associated with cardiovascular outcomes in 1,165 patients with coronary artery disease (> or =70% stenosis on the coronary angiogram) enrolled in the Intermountain Heart Collaborative Study. The exclusion criteria included previous myocardial infarction (MI) or HF, ejection fraction 2.30 ng/ml/h) and as tertiles ( or =1.90 ng/ml/h). Predefined cardiovascular outcomes were assessed for a minimum follow-up of 3 years (mean 6.4 +/- 3.2, maximum 14.6) using Cox regression analysis to adjust for the baseline characteristics. The mean patient age was 64.4 years; most patients were men (73.1%) and hypertensive (63.2%). Elevated baseline PRA (high vs low category; >2.30 vs < or =0.50 ng/ml/h) was associated with a significantly increased risk of 3-year cardiac morbidity/mortality (hazard ratio 1.96; p = 0.004), MI (hazard ratio 2.41; p = 0.02), HF hospitalization (hazard ratio 4.39; p = 0.03), and all-cause death (hazard ratio 1.80; p = 0.01). Elevated baseline PRA was also associated with longer-term HF hospitalization (hazard ratio 2.12; p = 0.004) and all-cause death (hazard ratio 1.56; p = 0.002). Similar results were observed for the PRA tertiles. The association of PRA with outcomes was observed after correction for hypertension, hyperlipidemia, diabetes, a family history of cardiovascular events, smoking, renal failure, and the use of statins. In conclusion, elevated baseline PRA is associated with cardiac morbidity and mortality in patients with coronary artery disease but normal left ventricular function and no previous MI or HF.

Joseph B Muhlestein - One of the best experts on this subject based on the ideXlab platform.

  • abstract 12842 both hyponatremia and elevated Plasma Renin Activity are independent and additive cardiovascular risk factors in patients with angiographically proven coronary artery disease cad the intermountain heart collaborative study
    Circulation, 2014
    Co-Authors: Tami L Bair, Jeffrey L Anderson, Benjamin D Horne, Joseph B Muhlestein
    Abstract:

    Background: Several studies have documented an increased risk of future major adverse cardiovascular events (MACE) among CAD patients with elevated baseline Plasma Renin Activity (PRA). One of the proposed mechanisms of elevated PRA is sodium depletion - hyponatremia. However, the relationship between PRA and hyponatremia is not well defined. Methods: A total of 1,781 pts with angiographic CAD (>50% stenosis) enrolled in the Intermountain Heart Collaborative Study were evaluated. Pts were excluded if they had a history of myocardial infarction (MI), heart failure (HF), left ventricular ejection fraction (EF) 2.3 ng/ml/h) and low (≤2.3 ng/ml/h) risk categories. The independent associations between these categories and MACE (death, MI, HF hospitalization, stroke and new onset renal failure) at five years were determined by multivariable Cox hazard...

  • relation of elevated Plasma Renin Activity at baseline to cardiac events in patients with angiographically proven coronary artery disease
    American Journal of Cardiology, 2010
    Co-Authors: Tami L Bair, Jeffrey L Anderson, Benjamin D Horne, Joseph B Muhlestein, Heidi T May, Margaret F Prescott, Richard H White
    Abstract:

    Plasma Renin Activity (PRA) is a measure of Renin-angiotensin system Activity and is associated with cardiovascular outcomes in patients with heart failure (HF). We conducted a prospective analysis to assess whether elevated baseline PRA is associated with cardiovascular outcomes in 1,165 patients with coronary artery disease (> or =70% stenosis on the coronary angiogram) enrolled in the Intermountain Heart Collaborative Study. The exclusion criteria included previous myocardial infarction (MI) or HF, ejection fraction 2.30 ng/ml/h) and as tertiles ( or =1.90 ng/ml/h). Predefined cardiovascular outcomes were assessed for a minimum follow-up of 3 years (mean 6.4 +/- 3.2, maximum 14.6) using Cox regression analysis to adjust for the baseline characteristics. The mean patient age was 64.4 years; most patients were men (73.1%) and hypertensive (63.2%). Elevated baseline PRA (high vs low category; >2.30 vs < or =0.50 ng/ml/h) was associated with a significantly increased risk of 3-year cardiac morbidity/mortality (hazard ratio 1.96; p = 0.004), MI (hazard ratio 2.41; p = 0.02), HF hospitalization (hazard ratio 4.39; p = 0.03), and all-cause death (hazard ratio 1.80; p = 0.01). Elevated baseline PRA was also associated with longer-term HF hospitalization (hazard ratio 2.12; p = 0.004) and all-cause death (hazard ratio 1.56; p = 0.002). Similar results were observed for the PRA tertiles. The association of PRA with outcomes was observed after correction for hypertension, hyperlipidemia, diabetes, a family history of cardiovascular events, smoking, renal failure, and the use of statins. In conclusion, elevated baseline PRA is associated with cardiac morbidity and mortality in patients with coronary artery disease but normal left ventricular function and no previous MI or HF.

Alice Stanton - One of the best experts on this subject based on the ideXlab platform.

  • aliskiren reduces blood pressure and suppresses Plasma Renin Activity in combination with a thiazide diuretic an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker
    Hypertension, 2007
    Co-Authors: Eoin Obrien, Patrick Dicker, Chris Jensen, David Mulcahy, John Barton, Juerg Nussberger, Alice Stanton
    Abstract:

    Thiazide diuretics, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers all cause reactive rises in Plasma Renin Activity. We hypothesized that Renin inhibition with aliskiren would prevent this reactive rise and also enhance blood pressure lowering. In 3 open-label studies in which blood pressure was assessed with ambulatory measurement, aliskiren was administered to patients with mild-to-moderate hypertension in combination with hydrochlorothiazide (n=23), ramipril (n=21), or irbesartan (n=23). In the diuretic combination study, the addition of 25 mg of hydrochlorothiazide to 150 mg of aliskiren daily for 3 weeks significantly lowered daytime pressure, compared with aliskiren monotherapy (systolic/diastolic mean change from baseline [SEM]: daytime: −18.4 [2.1]/ −10.6 [1.7] versus −10.4 [1.8]/−5.8 [1.4]; nighttime: −15.6 [2.7]/−8.1 [1.8] versus −8.8 [2.9]/−5.0 [2.2]). In the angiotensin-converting enzyme inhibitor combination study, the addition of 75 or 150 mg of aliskiren to 5 mg of ramipril alone for 3 weeks further lowered both daytime and nighttime pressures compared with ramipril monotherapy (daytime: −10.5 [2.9]/−8.1 [2.1] and −14 [3.7]/−8.7 [2.3] versus −6.1 [2.4]/−5.9 [1.5]; nighttime: −8.1 [2.6]/−5.3 [2.4] and −9.6 [3.4]/−5.3 [2.4] versus −2 [2.3]/−0.7 [2.2]). In the angiotensin receptor blocker combination study, the addition of 75 or 150 mg of aliskiren to 150 mg of irbesartan alone, for 3 weeks, resulted in significantly lower nighttime pressures compared with irbesartan monotherapy (daytime: −14.8 [2]/−8.2 [1.3] and −13.3 [1.6]/−6.8 [0.9] versus −11.4 [1.6]/−6.5 [1.1]; nighttime: −16.1 [2.4]/−8.6 [1.7] and −13.2 [2.7]/−7.2 [1.9] versus −9.0 [2.5]/−4.7 [1.9]). Aliskiren (150 mg) alone significantly inhibited Plasma Renin Activity by 65% ( P

  • aliskiren reduces blood pressure and suppresses Plasma Renin Activity in combination with a thiazide diuretic an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker
    Hypertension, 2007
    Co-Authors: Eoin Obrien, Patrick Dicker, Chris Jensen, David Mulcahy, John Barton, Juerg Nussberger, Alice Stanton
    Abstract:

    Thiazide diuretics, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers all cause reactive rises in Plasma Renin Activity. We hypothesized that Renin inhibition with aliskiren would prevent this reactive rise and also enhance blood pressure lowering. In 3 open-label studies in which blood pressure was assessed with ambulatory measurement, aliskiren was administered to patients with mild-to-moderate hypertension in combination with hydrochlorothiazide (n=23), ramipril (n=21), or irbesartan (n=23). In the diuretic combination study, the addition of 25 mg of hydrochlorothiazide to 150 mg of aliskiren daily for 3 weeks significantly lowered daytime pressure, compared with aliskiren monotherapy (systolic/diastolic mean change from baseline [SEM]: daytime: -18.4 [2.1]/ -10.6 [1.7] versus -10.4 [1.8]/-5.8 [1.4]; nighttime: -15.6 [2.7]/-8.1 [1.8] versus -8.8 [2.9]/-5.0 [2.2]). In the angiotensin-converting enzyme inhibitor combination study, the addition of 75 or 150 mg of aliskiren to 5 mg of ramipril alone for 3 weeks further lowered both daytime and nighttime pressures compared with ramipril monotherapy (daytime: -10.5 [2.9]/-8.1 [2.1] and -14 [3.7]/-8.7 [2.3] versus -6.1 [2.4]/-5.9 [1.5]; nighttime: -8.1 [2.6]/-5.3 [2.4] and -9.6 [3.4]/-5.3 [2.4] versus -2 [2.3]/-0.7 [2.2]). In the angiotensin receptor blocker combination study, the addition of 75 or 150 mg of aliskiren to 150 mg of irbesartan alone, for 3 weeks, resulted in significantly lower nighttime pressures compared with irbesartan monotherapy (daytime: -14.8 [2]/-8.2 [1.3] and -13.3 [1.6]/-6.8 [0.9] versus -11.4 [1.6]/-6.5 [1.1]; nighttime: -16.1 [2.4]/-8.6 [1.7] and -13.2 [2.7]/-7.2 [1.9] versus -9.0 [2.5]/-4.7 [1.9]). Aliskiren (150 mg) alone significantly inhibited Plasma Renin Activity by 65% (P<0.0001). Ramipril and irbesartan monotherapy caused 90% and 175% increases in Plasma Renin Activity, respectively. By contrast, when aliskiren was coadministered with hydrochlorothiazide, ramipril, or irbesartan, Plasma Renin Activity did not increase but remained similar to baseline levels or was decreased (combination therapy versus untreated; median [interquartile range]; aliskiren and hydrochlorothiazide: 0.4 [0.2 to 1.1] versus 0.7 [0.5 to 1.3]; ramipril and aliskiren: 0.5 [0.3 to 0.9] versus 0.6 [0.5 to 0.8]; irbesartan and aliskiren: 0.4 [0.2 to 0.9] versus 0.6 [0.4 to 0.9]). These results suggest that Renin inhibition with aliskiren in these combinations increases Renin-angiotensin system suppression, improves 24-hour blood pressure control, and may ultimately provide better end-organ protection in patients with hypertension.

Jean E Sealey - One of the best experts on this subject based on the ideXlab platform.

  • Plasma Renin Activity pra levels and antihypertensive drug use in a large healthcare system
    American Journal of Hypertension, 2012
    Co-Authors: Simran K Bhandari, Scott A Rasgon, Jean E Sealey, Kamyar Kalantarzadeh, John H Laragh
    Abstract:

    BACKGROUND: Although hypertension guidelines have utility in treating uncomplicated hypertension, they often overlook the pathophysiologic basis and heterogeneity of hypertension. This may explain the relatively poor hypertension control rates. A proposed approach is to guide addition and subtraction of medications using ambulatory Plasma Renin Activity (PRA) values. To evaluate the heterogeneity of hypertension and the medication burden associated with it, we investigated medication usage in relation to PRA among hypertensive patients within a large ethnically diverse organization. METHODS: A cross sectional data analysis was performed of hypertensive subjects with PRA measurements in the Kaiser Permanente Southern California database between 1 January 1998 and 31 October 2009. RESULTS: Among 7,887 such patients 0, 1, 2, ≥3 medication usage was 16%, 20%, 24%, 40% respectively. PRA levels ranged 1000-fold. Across PRA quartiles (Q1 to Q4) ≥3 meds were prescribed to 50%, 40%, 34%, 37%. From low to high PRA quartiles there was no usage trend for angiotensin converting enzyme inhibitors (ACEIs)/ angiotensin receptor blockers (ARBs) (71%), but diuretics increased (52%, 53%, 57%, 68%), calcium channel blocker's (CCB) fell (56%, 53%, 51%, 42%), and β-blockers fell (77%, 61%, 49%, 41%). Moreover, systolic BP fell (146, 142, 140, 135 mm Hg), blood urea nitrogen (BUN) rose (16, 17, 18, 20 mg/dl), serum uric acid rose (6.1, 6.3, 6.5, 6.9 mg/dl), and chronic kidney disease rose (22%, 22%, 23%, 27%). CONCLUSIONS: Polytherapy was the norm for treating hypertension. Lower PRAs were associated with higher blood pressures and more medications. Higher PRAs were associated with lower pressures and fewer medications. The results indicate that opportunities exist to simplify antihypertensive therapy by using current ambulatory PRA levels to guide drug selections and subtractions.

  • enduring direct association of baseline Plasma Renin Activity with all cause and cardiovascular mortality in hypertensive patients
    American Journal of Hypertension, 2011
    Co-Authors: Maday C Gonzalez, John H Laragh, Hillel W Cohen, Jean E Sealey, Michael H Alderman
    Abstract:

    Background Plasma Renin Activity (PRA) has been associated with cardiovascular disease mortality (CVD) events among hypertensive patients. We now report a long-term follow-up to assess the enduring association of PRA to CVD and all-cause mortality. methodS Participants (3,791) in a systematic hypertension treatment study had entry systolic blood pressure (BP) ≥140 mm Hg and mean age 52. CVD and all-cause mortality was ascertained for mean of 16 years. Pretreatment PRA was analyzed as a continuous variable, and by tertiles. The 10-year Framingham score was similarly examined. Hazard ratios (HRs) were estimated from multivariate Cox proportional hazard models. reSult S There were 804 deaths, and 360 (45%) were CVD. PRA was associated with all-cause mortality and CVD, but not cancer or non-CVD. Although T3 had lower mean baseline and follow-up systolic BP than T1, (146 vs. 152 mm Hg (P < 0.001) and 135 vs. 139 mm Hg (P < 0.001), respectively), T3 had 37% higher all-cause mortality (HR: 1.37, 95% confidence interval (CI): 1.15–1.63, P < 0.001) and 70% higher CVD mortality (HR: 1.70, 95% CI: 1.29–2.23, P < 0.001) after adjustment. The difference between T3 and T1 in mortality from coronary artery disease and myocardial infarction was more pronounced than for all CVD. PRA also significantly improved CVD risk estimation provided by Framingham. concluSionS These findings extend and reinforce previous evidence that pretreatment PRA has a significant, independent, specific, and direct long-term association with CVD mortality. Moreover, PRA adds significantly to risk identified by the Framingham score.

  • Plasma Renin Activity enzyme kinetic assay protection of angiotensin i from bacterial degradation
    Clinical Chemistry, 2011
    Co-Authors: Jean E Sealey, John H Laragh
    Abstract:

    To the Editor: Bystrom et al. (1) recently reported substantial peptidase Activity in human Plasma that had been incubated at 37 °C to generate angiotensin I (Ang I)1 during the clinical Plasma Renin Activity (PRA) assay. If this result is correct, it would call into question many of the PRA results previously reported by our laboratory and by Quest Diagnostics, especially those with low PRA (<0.65 μg · L− · h−). We believe, however, this observation is most likely an artifact caused by a failure to follow published protocols (2, 3). Several features of the Ang I degradation reported by …

  • effective Plasma Renin Activity a derived measure for assessing residual Plasma Renin Activity in patients taking angiotensin converting enzyme inhibitors or angiotensin receptor blockers
    Hypertension, 2010
    Co-Authors: Jean E Sealey, David Parra, Robert S Rosenstein, John H Laragh
    Abstract:

    To the Editor: The Plasma Renin Activity (PRA) test quantifies the circulating Activity of the Renin-angiotensin system by measuring the rate at which Renin forms angiotensin I (Ang I) in Plasma. The PRA test overestimates the true Activity of the circulating Renin-angiotensin system in patients taking angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) because these drugs block the system at sites distal to the enzymatic release of Ang I by Plasma Renin.1,2 When patients are taking these drugs, a simple calculation can be used to determine …

  • Plasma Renin Activity a risk factor for myocardial infarction in hypertensive patients
    American Journal of Hypertension, 1997
    Co-Authors: Michael H Alderman, Wee Lock Ooi, Hillel W Cohen, Shantha Madhavan, Jean E Sealey, John H Laragh
    Abstract:

    To determine whether pretreatment Plasma Renin Activity (PRA), without accompanying 24-h urine sodium, can predict myocardial infarction (MI), the PRA levels of 2,902 hypertensive patients [white (38%), male (65%), median age 55 years], with mean entry blood pressure (BP) of 150/97 mm Hg were examined. During an average 3.6 years follow-up (87% > or = 9 months), there were 55 MIs, 21 strokes, and 16 other cardiovascular disease (CVD) deaths. Classification of PRA levels into 3 Renin strata [high (H) PRA > or = 4.5 (n = 354), normal (N) 0.75 to 4.49 (n = 1,622), and low (L) or = 6.3 mmol/L (33% v 25%); all P values < .01. MI rates per 1,000/year were H: 9.3, N: 5.5, L: 2.5 (H v L, RR = 3.8, 95% CI: 1.7 to 8.4). A similar relationship was seen with total CVD (H: 12.5, N: 9.3, L: 5.2; RR = 2.4, 95% CI: 1.3 to 4.5) and all-cause mortality (H: 7.0, N: 6.2, L: 2.5; RR = 2.8, 95% CI: 1.2 to 6.8) but not CVA (H: 1.6, N: 2.0, L: 1.9). In a Cox survival analysis only Renin, age, sex, smoking, LVH, and cholesterol were significantly (P < .02) related to MI occurrence. There was, for every 2 unit increase in PRA, an overall 25% increase in MI incidence. Among hypertensive subjects, PRA level (without urine sodium), is independently and directly associated with the incidence of MI.