Renin: A Risk Factor for Cardiovascular Disease?

Sixty-seven of 80 patients with essential hypertension were prospectively studied for a mean 5 years. The prevalence of well-known risk factors had no apparent association with renin levels in these patients. But the incidence of cardiovascular events in patients with low plasma renin activity, measured in the supine or upright posture, was significantly lower than that in the normal- and high-renin groups combined. No cardiovascular events occurred in the low renin group; however, the data showed that patients with cardiovascular events had a higher prevalence of risk factors than those without. It is not clear whether renin activity itself is a risk factor or whether elevated renin activity is a "marker" for or consequence of other well-established risk factors. Low-renin hypertensive patients may be good risks, but, with our limited data, it seems inadvisable to withold hypertensive therapy from them.