The Renin System and Future Trends in Management of High Blood Pressure

Recent research has shown that the renin-angiotensin-aldosterone system plays a role in maintaining or causing high blood pressure in the majority of patients and it has demonstrated that renin-sodium profiling defines this involvement. Plasma renin activity measurements reveal the degree of renin-mediated vasoconstriction supporting the blood pressure, and the urinary sodium value indicates the appropriateness of the renin activity to the volume status. Together with determination of serum potassium levels, this test is basic for screening and for definitive diagnosis of the surgically curable forms of renovascular and adrenocortical hypertension. For the remaining majority of patients with other forms of hypertension, renin profiling, used in the context of the vaso-constriction-volume analytical model, helps to reveal the relative participation of vasoconstriction and volume factors and it thereby guides simpler, more specific, and more predictable treatments using either antirenin or antivolume agents. In particular, renin profiling allows the physician to select those patients who should first receive a beta-blocker or a newer anti-renin drug instead of a diuretic. The vasoconstriction-volume analysis also can provide useful baseline information about the pace, severity, and prognosis of the disease in individual patients. For medical practice the new approach enables treatment with one drug instead of two for major subgroups, and the likelihood of more specific physiologic corrections. More research within this framework promises even better treatments as we near final solutions.