Key result
Diuretics led to a sustained increase in plasma renin activity that was similar across classes (SMD 0.481-0.729; P=0.826 for difference) and unrelated to average blood pressure reduction.
Why the study?
It was unknown whether the effects of diuretics on plasma renin activity differ by diuretic class, whether they cause a sustained increase, and whether changes relate to blood pressure changes.
Does diuretic therapy increase plasma renin activity in patients with primary hypertension?
Meta-Analysis
Does diuretic therapy increase plasma renin activity in patients with primary hypertension?
Diuretic therapy leads to a sustained increase in plasma renin activity across all diuretic classes, independent of the magnitude of blood pressure reduction.
AIMS: Plasma renin activity (PRA) is regarded as a marker of sodium and fluid homeostasis in patients with primary hypertension. Whether effects of diuretics on PRA differ according to class of diuretic, whether diuretics lead to a sustained increase in PRA, and whether changes in PRA relate to those in blood pressure (BP) is unknown. We performed a systematic review and meta-analysis of trials investigating the antihypertensive effects of diuretic therapy in which PRA and/or other biomarkers of fluid homeostasis were measured before and after treatment. METHODS: Three databases were searched: MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials. Titles were firstly screened by title and abstract for relevancy before full-text articles were assessed for eligibility according to a predefined inclusion/exclusion criteria. RESULTS: A total of 1684 articles were retrieved of which 61 met the prespecified inclusion/exclusion criteria. PRA was measured in 30/61 studies. Diuretics led to a sustained increase in PRA which was similar for different classes of diuretic (standardised mean difference [95% confidence interval] 0.481 [0.362, 0.601], 0.729 [0.181, 1.28], 0.541 [0.253, 0.830] and 0.548 [0.159, 0.937] for thiazide, loop, mineralocorticoid receptor antagonists/potassium-sparing and combination diuretics respectively, Q = 0.897, P = .826), and did not relate to the average decrease in blood pressure. CONCLUSION: In antihypertensive drug trials, diuretics lead to a sustained increase in average PRA, which is similar across different classes of diuretic and unrelated to the average reduction in blood pressure.
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McNally et al. (2020) conducted a meta-analysis in Primary hypertension. Diuretics vs. Baseline (before treatment) was evaluated on Plasma renin activity (PRA) (SMD 0.481 (thiazide), 0.729 (loop), 0.541 (K-sparing), 0.548 (combination), 95% CI 0.362-0.601, 0.181-1.28, 0.253-0.830, 0.159-0.937, p=0.826). Diuretics led to a sustained increase in plasma renin activity that was similar across classes (SMD 0.481-0.729; P=0.826 for difference) and unrelated to average blood pressure reduction.
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