Why the study?
Does diuretic therapy (spironolactone, hydrochlorothiazide, or combination) improve hypotensive response differently in patients with low renin versus normal renin essential hypertension?
Does diuretic therapy (spironolactone, hydrochlorothiazide, or combination) improve hypotensive response differently in patients with low renin versus normal renin essential hypertension?
Patients with low renin essential hypertension exhibit a greater blood pressure reduction in response to diuretic therapies than those with normal renin, suggesting a volume-dependent pathogenesis.
Supports renin-guided diuretic selection in essential hypertension; extends RCT evidence for volume-dependent responses.
This study was designed to compare the effectiveness of spironolactone, hydrochlorothiazide, and combined spironolactone-hydrochlorothiazide therapy in patients with low renin and those with normal renin essential hypertension. Patients with low renin hypertension had a greater hypotensive response to each regimen (p less than 0.001). Low renin patients responded equally to both spironolactone and to hydrochlorothiazide, and in low renin but not in normal renin patients reduction of blood pressure correlated with weight loss. These results suggest that a volume factor, not specifically related to increased mineralocorticoid production, contributes to the pathogenesis of low renin essential hypertension.
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Brooks et al. (1977) studied this question.