Plasma renin activity in the emergency department and its independent association with acute myocardial infarction

Abstract

Elevated plasma renin activity (PRA) is associated with increased risk of future myocardial infarction (MI) in ambulatory hypertensive patients. The present study evaluated the relationship of PRA to the diagnosis of acute MI in patients presenting to an emergency department with suspected acute MI. PRA was measured upon entry to the emergency department, before any acute treatment, as part of the standard evaluation of 349 consecutive patients who were hospitalized for suspected MI. Diagnosis of acute MI was confirmed in 73 patients, and ruled out in 276. They did not differ in age (65.9 +/- 2 v 66.1 +/- 1 years), systolic (143 +/- 4 v 140 +/- 2 mm Hg), or diastolic (81 +/- 2 v 81 +/- 1 mm Hg) pressures. Median PRA was 2.7-fold higher in acute MI (0.89 v 0.33 ng/L/s; P < .001). In a multivariate analysis controlling for other cardiac risk factors and prior drug therapy, PRA as a continuous variable was the predominant independent factor associated with acute MI (P < .0001), followed by white race (P = .002) and history of hypertension (P = .047). The height of the PRA level upon entry to the emergency department was directly and independently associated with the diagnosis of acute MI. These new findings extend earlier reports because they encompass acute MI patients, include both hypertensive and normotensive patients, and control for potentially confounding variables. Based on these observations, a randomized clinical trial is warranted to determine whether measurement of PRA in acute MI could refine the process by which treatments are applied.

Prorenin and Renin-Induced Extracellular Signal-Regulated Kinase 1/2 Activation in Monocytes Is Not Blocked by Aliskiren or the Handle-Region Peptide

“…24,25 The recent clinical availability of aliskiren allows for direct renin inhibition and reduces PRA. In contrast, other inhibitors of the renin-Ang system increase PRA.…”

The Plasma Renin Test Reveals the Contribution of Body Sodium-Volume Content (V) and Renin-Angiotensin (R) Vasoconstriction to Long-Term Blood Pressure

“…20,40 The decision to initiate the treatment of the medium renin patients with an antirenin system drug rather than a natriuretic drug was based on reports that hypertensive patients with renin-dependent hypertension (those with medium or high PRA levels) are more likely to suffer myocardial infarctions than are those with low renin. [41][42][43][44] Taken altogether, it makes sense to block the activity of the renin system first in those hypertensive patients who already have plasma renin to block.…”

Plasma renin activity and risk of cardiovascular and mortality outcomes among individuals with elevated and nonelevated blood pressure

“…Using plasma renin activity (PRA) levels in clinical practice may provide insights into hypertension (HTN) and help improve cardiovascular and mortality outcomes [1]. PRA is a surrogate of renin–angiotensin system (RAS) activity and potentially serves as a biomarker for increased risk for cardiovascular events and mortality in the congestive heart failure (CHF), ischemic heart disease (IHD), and HTN populations [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13].…”

“…Studies on the hypertensive population have demonstrated an association between PRA and increased risk of cardiovascular events and mortality [1], [2], [3], [4], [5]. PRA values have also been shown to be associated with an increased risk of cardiovascular events and all-cause mortality in individuals with preexisting cardiovascular disease [6], [7], [8], [9], [10], [11], [12], [13].…”