Document Detail

Rationale for angiotensin II receptor blockers in patients with low-renin hypertension.
MedLine Citation:
PMID:  10986156     Owner:  NLM     Status:  MEDLINE    
African Americans outrank other ethnic groups in the United States in prevalence, early onset, and severity of hypertension. Furthermore, African Americans suffer the highest rates of mortality from cardiovascular, cerebrovascular, and end-stage renal disease. The recently concluded Heart Outcomes Prevention Evaluation (HOPE) study reports that the angiotensin-converting enzyme (ACE) inhibitor ramipril significantly reduced morbidity and mortality in a broad range of patients at high risk for cardiovascular events. These results strengthen the case for increasing the use of ACE inhibitor therapy. In accord with the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) guidelines, antihypertensive monotherapy for African Americans is based on the known ability of diuretics and calcium channel blockers to produce greater reductions in blood pressure in this population than those attainable with beta blockers and ACE inhibitors. The national guidelines also suggest ACE inhibitors for all hypertensive patients with left ventricular dysfunction or nephropathy, which implies that African Americans must cross a clinical threshold to become candidates for these agents. The rationale for delaying ACE inhibitor therapy is due in part to a perceived unique pathobiology in hypertensive African Americans: an excess prevalence of salt sensitivity, hypervolemia, and low plasma renin activity (PRA). At first glance, it would seem intuitive to avoid agents that further depress the renin-angiotensin system (RAS) and choose agents that reduce plasma volume. However, most hypertensive African Americans are not hypovolemic. Furthermore, dietary sodium restriction and diuretic therapy raise PRA and improve the response to ACE inhibitors. The overall aim of this article is to explain the rationale for expanded use of drugs that block the RAS in African Americans and low-renin populations.
K A Jamerson
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  36     ISSN:  0272-6386     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2000 Sep 
Date Detail:
Created Date:  2000-10-05     Completed Date:  2000-10-05     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  S24-30     Citation Subset:  IM    
University of Michigan Medical Center, Ann Arbor, MI 48109-0357, USA.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
African Americans
African Continental Ancestry Group
Angiotensin II / antagonists & inhibitors*
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Antihypertensive Agents / therapeutic use
Blood Pressure / drug effects
Blood Volume / physiology
Calcium Channel Blockers / therapeutic use
Diet, Sodium-Restricted
Diuretics / therapeutic use
Ethnic Groups
Hypertension / drug therapy*,  ethnology
Ramipril / therapeutic use
Receptors, Angiotensin / antagonists & inhibitors*
Renin / blood*
Risk Factors
United States
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Calcium Channel Blockers; 0/Diuretics; 0/Receptors, Angiotensin; 11128-99-7/Angiotensin II; 87333-19-5/Ramipril; EC

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

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