Abstract 18811: Plasma Renin Activity Test Versus US Joint National Committee Guidelines for Selecting Initial Antihypertensive Drug
Background: US National Guidelines promote initiating treatment for nearly all hypertensive patients with a natriuretic drug. We now report a double-blind, randomized controlled trial to compare that with a Plasma Renin Activity (PRA) test guided therapeutic approach.
Methods: Hypertensive participants (n=164) consented to (i) replacement of antihypertensive drugs with placebo for at least 4 weeks and then (ii) a 5 month double blind study to compare BP control and BP change achieved by initial monotherapy: Experimental = guided by PRA (n=82) v. Control = hydrochlorothiazide (HCTZ) (n=82).
Results: Eligible subjects were 45% males with a mean±SD age 60±9, entry BP 152±10/86±10mmHg,and median (IQR) PRA 0.7 (0.2, 1.4)ng/mL/hr. Experimental subjects were given a diuretic if PRA <0.65 (n=32?), or olmesartan if PRA ≥0.65 ng/mL/hr (n=50?). At 4 months, 72% of both Experimental and Control groups achieved BP <140/90mmHg, (132±15/76±11 v. 134±14/79±9mmHg,p=.39/.18 respectively). As expected, in subjects with PRA<0.65ng/mL/hr BP decline was similar in Experimental and Control groups. By contrast, in 91 patients with PRA ≥ .65ng/mL/hr, after adjusting for entry BP Experimental subjects (n=50) had a significantly greater mean±SE fall in systolic BP [_-4.9±2.4mmHg (p=.04)] and a borderline significantly greater fall when not adjusted (_-4.5±2.3mmHg, p=.06).
Conclusions: Effectiveness of PRA guided therapy is identical to US National Guidelines for patients with PRA < 0.65 ng/mL/hr. However, it significantly improved BP treatment in patients with PRA ≥ 0.65ng/ml/hr. Moreover, in this clinical trial of moderately hypertensive patients, initial monotherapy lowered BP to <140/90 mmHg in nearly 3/4 of subjects. These results suggest that routine PRA determination can improve both the effectiveness and efficiency of hypertension treatment.
- © 2012 by American Heart Association, Inc.