Relation of age, diastolic pressure and known duration of hypertension to presence of low renin essential hypertension

Tuck, Michael L.; Williams, Gordon H.; Cain, John P.; Sullivan, Jay M.; Dluhy, Robert G.

doi:10.1016/s0002-9149(73)80056-6

Cited by 141 publications

(38 citation statements)

References 17 publications

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“…This is consistent with findings reported by other authors evaluating normotensive subjects (30) and hypertensive patients (31), but it differs from other author's reports (32), where both ALD and PRA were found to decrease with age.…”

Section: Prc Subgroupsupporting

confidence: 91%

Screening for primary aldosteronism in an argentinian population: a multicenter prospective study

Reyna¹,

Gómez

Lupi

et al. 2015

Arch. Endocrinol. Metab.

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Objectives: Primary aldosteronism (PA) is characterized by the autonomous overproduction of aldosterone. Its prevalence has increased since the use of the aldosterone (ALD)/plasma renin activity (PRA) ratio (ARR). The objective of this study is to determine ARR and ARC (ALD/plasma renin concentration ratio) cut-off values (COV) and their diagnostic concordance (DC%) in the screening for PA in an Argentinian population. Design: multicenter prospective study. Subjects and methods: We studied 353 subjects (104 controls and 249 hypertensive patients). Serum aldosterone, PRA and ARR were determined. In 220 randomly selected subjects, 160 hypertensive patients and 60 controls, plasma renin concentration (PRC) was simultaneously measured and ARC was determined. Results: According to the 95 th percentile of controls, we determined a COV of 36 for ARR and 2.39 for ARC, with ALD ≥ 15 ng/dL. In 31/249 hypertensive patients, ARR was ≥ 36. PA diagnosis was established in 8/31 patients (23/31 patients did not complete confirmatory tests). DC% between ARR and ARC was calculated. A significant correlation between ARR and ARC (r = 0.742; p < 0.0001) was found only with PRA > 0.3 ng/mL/h and PRC > 5 pg/mL. DC% for ARR and ARC above or below 36 and 2.39 was 79.1%, respectively. Conclusion: This first Argentinian multicenter study determined a COV of 36 for ARR and 2.39 for ARC. Applying an ARR ≥ 36 in the hypertensive group, we confirmed PA in a higher percentage of patients than the previously reported one in our population. As for ARC, further studies are needed for its clinical application, since DC% is acceptable only for medium range renin values. Arch Endocrinol Metab. 2015;59(5):441-7

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Section: Prc Subgroupsupporting

confidence: 91%

Screening for primary aldosteronism in an argentinian population: a multicenter prospective study

Reyna¹,

Gómez

Lupi

et al. 2015

Arch. Endocrinol. Metab.

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“…[34][35][36][37][38][39] The present finding of a negative correlation between PRA and age in patients with EH is consistent with previous reports of ours as well as those of other laboratories. [40][41][42][43] …”

Section: Methodsmentioning

confidence: 99%

Splanchnic blood flow in essential hypertension and in hypertensive patients with renal artery stenosis.

Messerli¹,

Genest²,

Nowaczynski³

et al. 1975

Circulation

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SUMMARYSplanchnic blood flow (SBF) was measured simultaneously with cardiac output (dye dilution) and intraarterial blood pressure by constant infusion of indocyanine green in 11 control subjects, 13 patients with essential hypertension (EH) and seven hypertensive patients with renal artery stenosis (RAS). The cardiac index (CI) was lower (P < 0.05) in patients with EH (3.17 ± 0.07 L/min/m2) (mean i SEMI) than in control subjects (3.43 ± 0.09). Associated with the lower CI was a significantly (P < 0.01) lower SBF same group reported a mean SBF of 755 ml/min/m2 in 41 hypertensive subjects and 798 ml/min/m2 in their 21 normal controls.2 In contrast, Pippig and Schmitt,3 using colloidal chromic-32 phosphate and an external counting system, reported a 20% lower value in 45 essential hypertensive subjects than in 40 normal controls. Other than these contradictory reports, no conclusive data on this subject have been presented. In addition, no data were provided about the type and stage of hypertension studied and obstructive lesions of the renal arteries were not eliminated in patients with EH.The above fact is of considerable importance because a reduction in SBF could be expected to slow down the metabolism of physiological and pharmacological substances by the liver. This in turn might cause an increased plasma level of these agents. We have measured SBF in well-defined hypertensive patients and control subjects according to the principle of Bradley et al.4 by a constant infusion of indocyanine green (ICG).5 Cardiac output and intra-

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“…For the upright-posture study, plasma renin activity (PRA) was obtained after the subject had been standing upright or walking quietly for 1.5 to 2 hours, as previously described. 11 Ang II infusion was accomplished as follows. Each subject received an infusion of Ang II amide (Hypertensin, CIBA-Geigy) at 3 ng · kg Ϫ1 · min Ϫ1 for 40 minutes.…”

Section: Protocolmentioning

confidence: 99%

“…11 The non-low renin subjects were further classified as modulators or NMs based on their ALDO response to Ang II. An increment թ15 ng/dL defined the NM phenotype.…”

Section: Laboratory Proceduresmentioning

confidence: 99%

Genetic Determinants of Nonmodulating Hypertension

et al. 2003

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Abstract-We sought to determine whether genes of the renin-angiotensin-aldosterone system can predict the nonmodulating intermediate phenotype in essential hypertension. Aldosterone responses to angiotensin II were assessed in 298 subjects with hypertension. Subjects were genotyped at the angiotensinogen M235T, angiotensin-converting enzyme I/D, aldosterone synthase CϪ344 T, renin, angiotensin II type 1 receptor, and adducin loci. The data were analyzed by Student t test, ANOVA, stepwise linear regression and general linear model or GENMOD regression techniques, and 2 analysis odds ratios (ORs). Aldosterone response varied by genotype for angiotensin and aldosterone synthase but not for the other loci. The combination of angiotensinogen 235 TT and angiotensin-converting enzyme DD showed further reduction (Pϭ0.0377) when compared with angiotensinogen 235 TT alone, an example of genetic epistasis. When the subject was required also to possess the CYP11B2 Ϫ344 TT genotype, there was a further substantial reduction. Of these 3 loci, only angiotensinogen 235 TT significantly increased the OR of predicting the nonmodulating hypertensive phenotype (OR, 2.00; 95% confidence interval, 1.152 to 3.51). However, when angiotensin-converting enzyme DD was combined with angiotensinogen 235 TT, the OR nearly doubled to 3.74, with a further increase to 5.36-fold when the subject possessed all 3 genotypes. Thus, the angiotensinogen, angiotensin-converting enzyme, and aldosterone synthase genotypes identified individuals with the nonmodulating phenotype with an increasing degree of fidelity. For this subclass of essential hypertension, it is likely that genotyping can be substituted for complex phenotyping for therapeutic and preventive decision making.

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Relation of age, diastolic pressure and known duration of hypertension to presence of low renin essential hypertension

Cited by 141 publications

References 17 publications

Screening for primary aldosteronism in an argentinian population: a multicenter prospective study

Screening for primary aldosteronism in an argentinian population: a multicenter prospective study

Splanchnic blood flow in essential hypertension and in hypertensive patients with renal artery stenosis.

Genetic Determinants of Nonmodulating Hypertension

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