Document Detail

Does the ratio of serum aldosterone to plasma renin activity predict the efficacy of diuretics in hypertension? Results of RENALDO.
MedLine Citation:
PMID:  20009770     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We hypothesized that the aldosterone: renin ratio (ARR) predicts the antihypertensive response to mineralocorticoid receptor antagonist, spironolactone (SPIRO), when compared with bendroflumethiazide (BFZ).
METHODS: We conducted a randomized, crossover, trial on hypertensive patients with either high ARR (HARR defined as >750 and plasma aldosterone >250 pmol/l) or low ARR (LARR defined as <300 and plasma renin activity <10 ng/ml per h). Each group took SPIRO 50 mg once daily for 12 weeks and BFZ 2.5 mg once daily for 12 weeks in random order separated by 2-week washout. Patients with mean 24-h systolic ambulatory blood pressure (SABP) at least 140 mmHg were included. Primary endpoint was difference in SABP between SPIRO and BFZ in patients with HARR compared with those with LARR.
RESULTS: One hundred and eleven patients (60 HARR and 51 LARR) completed the study. SABP at 12 weeks in the HARR group was 129.4 mmHg on SPIRO and 134.4 mmHg on BFZ [difference -5.01; 95% confidence interval (CI) -7.51, -2.52; P < 0.0002]. In the LARR group, SABP was 129.7 mmHg on SPIRO and 133.1 mmHg on BFZ [difference -3.43 (95% CI -6.18, -0.68) P < 0.01]. Difference between groups (HARR vs. LARR) was -1.58 mmHg (95% CI 5.25, -2.08; not significant, P = 0.394). In a secondary analysis of the overall study population of 111 patients, SABP reduction with SPIRO 50 mg was superior to BFZ 2.5 mg [SPIRO -14.8 mmHg, BFZ -10.5 mmHg, difference -4.29 mmHg (95% CI -6.12, -2.46)]. Results were similar for secondary endpoints. Plasma renin activity or aldosterone did not predict blood pressure response to SPIRO. Results were independent of concomitant angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use.
CONCLUSION: The ARR did not predict the blood pressure response to SPIRO. SPIRO 50 mg was significantly more effective than BFZ 2.5 mg in lowering SABP irrespective of baseline ARR, plasma renin activity or aldosterone.
Hari K Parthasarathy; Khamis Alhashmi; Alex D McMahon; Allan D Struthers; Gordon T McInnes; Ian Ford; John M Connell; Thomas M MacDonald
Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of hypertension     Volume:  28     ISSN:  1473-5598     ISO Abbreviation:  J. Hypertens.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-17     Completed Date:  2010-03-09     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  170-7     Citation Subset:  IM    
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MeSH Terms
Aldosterone / blood*
Bendroflumethiazide / therapeutic use*
Blood Pressure / drug effects,  physiology
Cross-Over Studies
Diuretics / therapeutic use*
Drug Therapy, Combination
Hyperaldosteronism / drug therapy,  physiopathology
Hypertension / blood,  drug therapy*,  physiopathology
Middle Aged
Predictive Value of Tests
Renin / blood*
Spironolactone / therapeutic use*
Treatment Outcome
Grant Support
G0400874//Medical Research Council; //Chief Scientist Office
Reg. No./Substance:
0/Diuretics; 27O7W4T232/Spironolactone; 4964P6T9RB/Aldosterone; 5Q52X6ICJI/Bendroflumethiazide; EC
Comment In:
Curr Hypertens Rep. 2010 Dec;12(6):395-8   [PMID:  21046491 ]
J Hypertens. 2011 Jan;29(1):171   [PMID:  21160364 ]
J Hypertens. 2010 Jan;28(1):13-4   [PMID:  20016304 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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