Title: Volume factor in low and normal renin essential hypertension
Abstract: The blood pressure response to spironolactone or chlorthalidone was studied in 71 patients with essential hypertension exhibiting either low or normal plasma renin activity. The patients with low renin activity were more responsive to both of these diuretic agents, but neither drug was uniquely or uniformly effective in this group. Blood pressure became normal in only 57 percent of patients with reduced renin activity receiving spironolactone therapy, whereas 24 percent maintained a diastolic pressure greater than 105 mm Hg; 44 percent of them responded to chlorthalidone, but 31 percent did not. In patients with normal renin values the blood pressure was normalized in 36 percent by spironolactone and in 37.5 percent by chlorthalidone. Responses to spironolactone were usually manifested with a dose of 100 mg/day; an increased dose rarely had an additional antihypertensive effect. The similar effectiveness of both drugs in 27 patients treated sequentially with each agent suggests that volume depletion is a common mechanism of action. The sustained induced elevations of plasma renin activity and aldosterone excretion, and the chronic elevations of blood urea nitrogen induced by both agents, indicate that a persistent shift or loss of body sodium or water occurs during therapy. Thus, the antihypertensive action of either diuretic agent appears to result from a reduction of a possibly excessive sodium or volume content relative to capacity of the vascular bed. Patients failing to respond may have had inadequate volume depletion or a hypertensive state that was maintained by a relatively greater vasoconstrictor (renin) response for the degree of volume depletion induced by the drug. Altogether the data suggest that diuretic therapy with either spironolactone or a sulfonamide is primarily indicated in low renin essential hypertension. In patients with normal renin activity diuretic therapy could be reserved for those in whom beta adrenergic blockade proves inadequate. Such sequential single-drug antihypertensive therapy offers the potential for further characterization and understanding of hypertensive disorders while affording a simpler and more specific long-term drug regimen for some patients. The blood pressure response to spironolactone or chlorthalidone was studied in 71 patients with essential hypertension exhibiting either low or normal plasma renin activity. The patients with low renin activity were more responsive to both of these diuretic agents, but neither drug was uniquely or uniformly effective in this group. Blood pressure became normal in only 57 percent of patients with reduced renin activity receiving spironolactone therapy, whereas 24 percent maintained a diastolic pressure greater than 105 mm Hg; 44 percent of them responded to chlorthalidone, but 31 percent did not. In patients with normal renin values the blood pressure was normalized in 36 percent by spironolactone and in 37.5 percent by chlorthalidone. Responses to spironolactone were usually manifested with a dose of 100 mg/day; an increased dose rarely had an additional antihypertensive effect. The similar effectiveness of both drugs in 27 patients treated sequentially with each agent suggests that volume depletion is a common mechanism of action. The sustained induced elevations of plasma renin activity and aldosterone excretion, and the chronic elevations of blood urea nitrogen induced by both agents, indicate that a persistent shift or loss of body sodium or water occurs during therapy. Thus, the antihypertensive action of either diuretic agent appears to result from a reduction of a possibly excessive sodium or volume content relative to capacity of the vascular bed. Patients failing to respond may have had inadequate volume depletion or a hypertensive state that was maintained by a relatively greater vasoconstrictor (renin) response for the degree of volume depletion induced by the drug. Altogether the data suggest that diuretic therapy with either spironolactone or a sulfonamide is primarily indicated in low renin essential hypertension. In patients with normal renin activity diuretic therapy could be reserved for those in whom beta adrenergic blockade proves inadequate. Such sequential single-drug antihypertensive therapy offers the potential for further characterization and understanding of hypertensive disorders while affording a simpler and more specific long-term drug regimen for some patients.
Publication Year: 1973
Publication Date: 1973-09-01
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
Access and Citation
Cited By Count: 194
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