Using Renin Activity to Guide Mineralocorticoid Receptor Antagonist Therapy in Patients with Low Renin and Hypertension.
Using Renin Activity to Guide Mineralocorticoid Receptor Antagonist Therapy in Patients with Low Renin and Hypertension.
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DOI：
10.1093/ajh/hpad032
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发表时间：
2023-07-14
影响因子：
3.2
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中科院分区：
文献类型：
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盐皮质激素受体拮抗剂（MRA）通常经验性地用于低肾素高血压（LRH）或可能的原发性醛固酮增多症（PA）患者，这些患者拒绝手术。然而，MRA治疗的最佳方法是未知的。研究表明，升高的肾素是预防PA心血管并发症的有效生物标志物。本研究旨在确定经验性MRA治疗LRH或可能的PA患者靶向未抑制的肾素是否与血压和/或蛋白尿降低相关。2005年至2021年的回顾性单中心队列研究包括LRH或可能的PA（肾素活性<1.0 ng/ml/h和可检测的醛固酮水平）成人。所有患者均经验性地接受了MRA治疗，靶向肾素≥ 1.0 ng/ml/h。在研究的39例患者中，32例（82.1%）达到非抑制性肾素。收缩压和舒张压分别从148.0和81.2降至125.8和71.6 mm Hg（P <0.001）。无论患者的醛固酮水平是高（> 10 ng/dl）还是低（<10 ng/dl），都可以观察到类似的血压降低。大多数（24/39; 61.5%）患者至少停用一种基线降压药物。在治疗后可检测到蛋白尿和白蛋白/肌酐（ACR）测量值的6例患者中，平均ACR从179.0 mg/g降至36.1 mg/g（P = 0.03）。研究中没有患者因不良反应而完全停止治疗。经验性MRA治疗LRH或可能的PA患者靶向未抑制的肾素可以安全有效地改善血压控制和减少蛋白尿。
Mineralocorticoid receptor antagonists (MRAs) are often empirically used for patients with low-renin hypertension (LRH) or probable primary aldosteronism (PA) who decline surgery. However, the optimal approach to MRA therapy is unknown. Studies have shown that a rise in renin is an effective biomarker of prevention of cardiovascular complications of PA. This study aimed to determine whether empiric MRA therapy in patients with LRH or probable PA targeting unsuppressed renin is associated with a decrease in blood pressure and/or proteinuria. Retrospective single-center cohort study from 2005 to 2021 included adults with LRH or probable PA (renin activity <1.0 ng/ml/h and detectable aldosterone levels). All patients were empirically treated with an MRA, targeting renin ≥1.0 ng/ml/h. Out of 39 patients studied, 32 (82.1%) achieved unsuppressed renin. Systolic and diastolic blood pressure decreased from 148.0 and 81.2 to 125.8 and 71.6 mm Hg, respectively (P < 0.001 for both). Similar blood pressure reductions were seen whether patients had high (>10 ng/dl) or low (<10 ng/dl) aldosterone levels. The majority (24/39; 61.5%) of patients had at least one baseline anti-hypertensive medication stopped. Among the six patients who had detectable proteinuria and albumin-to-creatinine (ACR) measurements post-treatment, the mean ACR decreased from 179.0 to 36.1 mg/g (P = 0.03). None of the patients studied had to completely stop treatment due to adverse reactions. Empiric MRA therapy in patients with LRH or probable PA targeting unsuppressed renin can safely and effectively improve blood pressure control and reduce proteinuria.
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