Plasma Renin Activity (PRA) Levels and Antihypertensive Drug Use in a Large Healthcare System
Plasma Renin Activity (PRA) Levels and Antihypertensive Drug Use in a Large Healthcare System
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DOI：
10.1038/ajh.2011.216
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发表时间：
2012-03-01
影响因子：
3.2
通讯作者：
Laragh, John H.
中科院分区：
文献类型：
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作者：
Sim, John J.;Bhandari, Simran K.;Laragh, John H.
尽管高血压指南在治疗无并发症的高血压方面具有实用性，但它们往往忽视了高血压的病理生理基础和异质性。这可能解释了相对较差的高血压控制率。一种建议的方法是使用动态血浆肾素活性（PRA）值来指导药物的添加和减少。为了评估高血压的异质性和与之相关的药物负担，我们调查了一个大型种族多元化组织中高血压患者与PRA相关的药物使用情况。方法对1998年1月1日至2009年10月31日期间在Kaiser Permanente Southern加州数据库中使用PRA测量的高血压受试者进行横断面数据分析。887例患者0、1、2、>= 3次用药率分别为16%、20%、24%、40%。PRA水平范围为1000倍。在PRA四分位数（Q1至Q4）中，≥ 3种药物的处方率分别为50%、40%、34%、37%。从低PRA四分位数到高PRA四分位数，血管紧张素转换酶抑制剂（ACEIs）/血管紧张素受体阻滞剂（ARB）（71%）的使用没有趋势，但利尿剂增加（52%，53%，57%，68%），钙通道阻滞剂（CCB）下降（56%，53%，51%，42%），β受体阻滞剂下降（77%，61%，49%，41%）。收缩压下降（146、142、140、135 mm Hg），血尿素氮（BUN）升高（16、17、18、20 mg/dl），血尿酸升高（6.1、6.3、6.5、6.9 mg/dl），慢性肾脏病升高（22%、22%、23%、27%）。较低的PRA与较高的血压和更多的药物有关。较高的PRA与较低的压力和较少的药物有关。结果表明，存在的机会，以简化降压治疗，利用目前的动态PRA水平，以指导药物的选择和削减。
BACKGROUNDAlthough 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.METHODSA 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.RESULTSAmong 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 beta-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%).CONCLUSIONSPolytherapy 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.