Plasma Renin in Congestive Heart Failure in Man

Conflicting reports of changes in renin activity and angiotensin in congestive heart failure, together with the recent suggestion that the hyperaldosteronism observed is a result of therapy, prompted a reevaluation of the renin-angiotensin system in this condition. Plasma renin activity in seven patients before therapy was in the normal range for upright subjects receiving a liberal sodium Intake. Of six patients for whom renin activity was determined serially during treatment, five showed a marked rise from a pretreatment mean level of 432 ng/100 ml in three hours to 1,402 ng/100 ml in three hours on the second or third day of treatment. This resembles the normal physiological response of the renin-anglotensin system to sodium loss. These findings support the suggestion that in heart failure hyperaldosteronism occurs only after treatment is commenced and indicate a possible therapeutic role for aldosterone antagonists in its management.