A Comparative Pilot Study of Plasma Renin Activity Guided Versus Usual Treatment in Patients With Untreated Young Adults

Objective: Primary aldosteronism screening is recommended when diagnosing hypertension in its early stages. In addition, renin–guided treatment using plasma renin activity (PRA) values may lead to significant blood pressure (BP) reductions especially in young adults. We compared the effect of renin-guided therapy versus (not renin-based) usual practice on short-term BP reductions in young untreated hypertensive patients who mostly have high renin activity and would benefit from renin-targeted antihypertensive drugs.Design and method: After excluding secondary hypertension such as primary aldosteronism, 32 untreated hypertensive young patients less than 55 years old were randomized to either renin-guided group (PRA group, n=16) or usual practice (Control group, n=16) managed by different specialists in hypertension clinic. After the blood samples for PRA were drawn at the first visit, randomization was made after one week. PRA group received antihypertensive drug based on their PRA, i.e. either angiotensin converting enzyme inhibitor or angiotensin receptor blocker if their PRA >= 0.65 ng/ml/h, calcium antagonist or diuretics if PRA< 0.65 ng/ml/h. Control group received antihypertensive drug selected by a specialist blinded to PRA value. If the BP has not reached the goal (<140/90mmHg) after 2 months, other class of antihypertensive drugs were added in both groups. Results: PRA group showed similar BP reduction after one-year study period (systolic BP, 126.2±9.4 vs 128.0±10.5 mmHg; diastolic BP, 80.8±6.1 vs 78.4±7.2 mmHg) compared to Control group. Conclusions: Plasma renin activity-guided treatment in young untreated hypertension does not seem to be more effective for the short-term BP reduction than the usual practice.