Diuretics led to a sustained increase in plasma renin activity that was similar across classes (SMD 0.481-0.729; P=0.826 for difference) and unrelated to average blood pressure reduction.
Meta-Analysis
Does diuretic therapy increase plasma renin activity in patients with primary hypertension?
Diuretic therapy leads to a sustained increase in plasma renin activity across all diuretic classes, independent of the magnitude of blood pressure reduction.
Effect estimate: SMD 0.481 (thiazide), 0.729 (loop), 0.541 (K-sparing), 0.548 (combination) (95% CI 0.362-0.601, 0.181-1.28, 0.253-0.830, 0.159-0.937)
p-value: p=0.826
AIMS: Plasma renin activity (PRA) is regarded as a marker of sodium and fluid homeostasis in patients with primary hypertension. Whether effects of diuretics on PRA differ according to class of diuretic, whether diuretics lead to a sustained increase in PRA, and whether changes in PRA relate to those in blood pressure (BP) is unknown. We performed a systematic review and meta-analysis of trials investigating the antihypertensive effects of diuretic therapy in which PRA and/or other biomarkers of fluid homeostasis were measured before and after treatment. METHODS: Three databases were searched: MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials. Titles were firstly screened by title and abstract for relevancy before full-text articles were assessed for eligibility according to a predefined inclusion/exclusion criteria. RESULTS: A total of 1684 articles were retrieved of which 61 met the prespecified inclusion/exclusion criteria. PRA was measured in 30/61 studies. Diuretics led to a sustained increase in PRA which was similar for different classes of diuretic (standardised mean difference 95% confidence interval 0.481 0.362, 0.601, 0.729 0.181, 1.28, 0.541 0.253, 0.830 and 0.548 0.159, 0.937 for thiazide, loop, mineralocorticoid receptor antagonists/potassium-sparing and combination diuretics respectively, Q = 0.897, P = .826), and did not relate to the average decrease in blood pressure. CONCLUSION: In antihypertensive drug trials, diuretics lead to a sustained increase in average PRA, which is similar across different classes of diuretic and unrelated to the average reduction in blood pressure.
McNally et al. (Wed,) conducted a meta-analysis in Primary hypertension. Diuretics vs. Baseline (before treatment) was evaluated on Plasma renin activity (PRA) (SMD 0.481 (thiazide), 0.729 (loop), 0.541 (K-sparing), 0.548 (combination), 95% CI 0.362-0.601, 0.181-1.28, 0.253-0.830, 0.159-0.937, p=0.826). Diuretics led to a sustained increase in plasma renin activity that was similar across classes (SMD 0.481-0.729; P=0.826 for difference) and unrelated to average blood pressure reduction.