Renin hypertension

Azizi, M., Guyene, T. T., ChateUier, G., Wargon, M., and Menard, J. (1997) Additive effects of losartan and enalapril on blood pressure and plasma active renin. Hypertension. 29, 634-640. 

Niarchos AP, Pickering TG Wallace JM, Case DB, Laragh JH. (1980) Hemodynamic effects of the converting enzyme inhibitor teprotide in normal- and high-renin hypertension. Clin Pharmacol Ther 28 592-601. 

Propranolol Block 3i and 32 receptors Lower HR and BP reduce renin Hypertension angina pectoris arrhythmias migraine hyperthyroidism Oral, parenteral Toxicity Bradycardia worsened asthma fatigue vivid dreams cold hands... 

Renin, angiotensin, and aldosterone play important roles in at least some people with essential hypertension. Approximately 20% of patients with essential hypertension have inappropriately low and 20% have inappropriately high plasma renin activity. Blood pressure of patients with high-renin hypertension responds well to drugs that interfere with the system, supporting a role for excess renin and angiotensin in this population. 

Increased production of deoxycorticosterone causes fluid retention. Because this hormone suppresses the renin/angiotensin system, it causes low-renin hypertension. 

Holhfield JW. Failure of aspirin to antagonize the antihypertensive effect of spironolactone in low-renin hypertension. South Med J 1976 69(8) 1034-6. 

Figure 51-M PRA correlated to urinary sodium excretion. (From Laragh JH, Sealey j, Brunner HR. The control of aldosterone secretion in normal and hyperactive man Abnormal renin and aldosterone patterns in low renin hypertension. Am J Med I972 53 649.)...

Hirohara D, Nomura K, Okamoto T, et al. Performance of the basal aldosterone to renin ratio and of the renin stimulation test by furosemide and upright posture in screening for aldosterone-producing adenoma in low renin hypertensives. J CUn Endocrinol Metab 2001 86 4292-4298. 

In the treatment of hypertension, a major use of beta-blockers is in combination with hydralazine. The direct vasodilators bring about reflex cardiac stimulation, and beta-blockers prevent these adverse effects (see also Figure 67). Beta-blockers also reduce blood pressure by exerting a central effect or a peripheral action, or both, which decreases renin activity. Metoprolol and atenolol are beta selective, and they are safer agents in patients with asthma, diabetes mellitus, or low-renin hypertension. Some beta-blocking agents such as pindolol have intrinsic sympathomimetic activity and may be used in the treatment of pronounced bradycardia (sick sinus syndrome). Unlike propranolol, metoprolol is not a very lipid-soluble... 

Jamerson KA Rationale for angiotensin II receptor blockers in patients with low-renin hypertension... 

THERAPEUTIC USES When given in adequate doses, the ATj receptor antagonists appear to be as effective as ACE inhibitors in the treatment of hypertension. As with ACE inhibitors, these drugs may be less effective in African Americans and patients with low-renin hypertension. The full effect of AT receptor antagonists on blood pressure typically is not observed until 4 weeks after initiation of therapy. If blood pressure is not controlled by an ATj receptor antagonist alone, a low dose of a thiazide or other diuretic may be added. In patients with mild-to-severe hypertension, the... 

An unknown pressor agent has been observed in the blood of animals and man with VE, low renin, hypertension. 3 Suppressed Na, K -ATPase activity in cardiovascular tissues of animals with either one-kidney renal, deoxycorticosterone acetate or reduced renal mass hypertension suggests that this pressor substance is an inhibitor of the Na ,K -ATPase. By inhibiting the Na, K -ATPase of vascular smooth muscle, it is possible that such an agent could contribute to increased vascular resistance or... 

---