Plasma renin testing to guide antihypertensive therapy.
Journal Article (Journal Article;Review)
Plasma renin activity (PRA)-guided therapy has been proposed as a strategy for selecting antihypertensive medications matched to the patient's underlying pathophysiology. To date, there are only a few studies that have sought to compare a PRA-guided strategy to usual care. In one trial of 363 untreated patients, based on home blood pressure (BP) averages, PRA was predictive of responses to beta-blocker and thiazide diuretic as monotherapy and add-on therapy. In another trial of 77 treated but uncontrolled patients, a PRA-guided strategy was superior to clinical hypertension specialist care for guiding add-on or subtraction (stopping an agent that might cause a paradoxical pressor response) therapy. In the ValVET study, PRA-guided therapy was not superior to fixed-dose therapy consisting of an angiotensin receptor blocker and hydrochlorothiazide. One modeling study found a PRA-guided strategy may be cost-effective compared to standard care for younger patients and those with a greater number of cardiovascular risk factors. We conclude that additional, well-designed randomized trials with sufficient sample sizes comparing PRA-guided management to usual care are needed to clarify whether this strategy should be adopted broadly.
Full Text
Duke Authors
Cited Authors
- Viera, AJ; Furberg, CD
Published Date
- January 2015
Published In
Volume / Issue
- 17 / 1
Start / End Page
- 506 -
PubMed ID
- 25432898
Electronic International Standard Serial Number (EISSN)
- 1534-3111
Digital Object Identifier (DOI)
- 10.1007/s11906-014-0506-0
Language
- eng
Conference Location
- United States