Document Detail

The renin-angiotensin system in malignant hypertension revisited: plasma renin activity, microangiopathic hemolysis, and renal failure in malignant hypertension.
MedLine Citation:
PMID:  17679041     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Malignant hypertension is a renin-dependent form of hypertension. However, the variations in renin-angiotensin system (RAS) activation in malignant hypertension are not completely understood. A proposed mechanism for ongoing RAS activation is the presence of microangiopathic hemolysis resulting in renovascular ischemia. METHODS: We prospectively examined the association between plasma renin activity (PRA), microangiopathic hemolysis, and renal dysfunction in 30 consecutive patients with malignant hypertension (n=18) and severe hypertension (n=12). The PRA and aldosterone were measured in the supine position and before initiating therapy. RESULTS: The PRA was 8.8 ng angiotensin I (AI)/mL/h (interquartile range [IQR] 4.8-20) in malignant hypertensive patients and 2.8 ng AI/mL/h (IQR 0.6-6.3) in patients with severe hypertension (P<.01). Aldosterone was 1.30+/-1.02 nmol/L in patients with malignant hypertension compared with 0.44+/-0.37 nmol/L in those with severe hypertension (P<.01). In malignant hypertension, PRA highly correlated with lactic dehydrogenase (LDH) (r=0.76, P<.001), meaning that 58% of the variations in PRA could be explained by LDH. The PRA positively correlated with serum creatinine values at presentation (r=0.50, P=.007), but adjustment for LDH abolished the effect of PRA on creatinine (P=.24). CONCLUSIONS: The PRA and aldosterone were markedly elevated in patients with malignant hypertension but not in severely hypertensive patients despite small differences in blood pressure (BP). The strong logarithmic correlation between PRA, microangiopathic markers, and renal dysfunction suggests a renin-mediated acceleration of vascular damage and renal dysfunction in patients with malignant hypertension.
Bert-Jan H van den Born; Richard P Koopmans; Gert A van Montfrans
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of hypertension     Volume:  20     ISSN:  0895-7061     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-06     Completed Date:  2007-10-25     Revised Date:  2009-02-24    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  United States    
Other Details:
Languages:  eng     Pagination:  900-6     Citation Subset:  IM    
Department of Internal and Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Aldosterone / blood
Biological Markers / blood
Creatinine / blood
Follow-Up Studies
Hemolysis / physiology*
Hypertension, Malignant / blood*,  complications,  physiopathology
Kidney Failure / blood,  etiology*,  physiopathology
Middle Aged
Prospective Studies
Renin / blood*
Renin-Angiotensin System / physiology*
Risk Factors
Severity of Illness Index
Reg. No./Substance:
0/Biological Markers; 52-39-1/Aldosterone; 60-27-5/Creatinine; EC

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

Previous Document:  Reduced cardiovascular reactivity to stress but not feeding in renin enhancer knockout mice.
Next Document:  Effects of angiotensin receptor blockers on ambulatory plasma Renin activity in healthy, normal subj...