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July 4, 1980, Vol 244, No. 1 >
ARTICLE | July 4, 1980

Is the Renin-Sodium Profile Helpful in Evaluating Hypertension? FREE

Ray W. Gifford, MD
[+] Author Affiliations

Reprint requests to the Department of Hypertension and Nephrology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44106 (Dr Gifford).


JAMA. 1980;244(1):35-37. doi:10.1001/jama.1980.03310010021020
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References

LARAGH and colleagues1 have long advocated measurement of plasma renin activity (PRA) routinely in the evaluation of hypertensive patients. They have presented an elaborate and somewhat complicated schema for using the PRA as an aid in diagnostic evaluation and in selecting drugs. Reliable measurements of PRA are not readily available to many physicians, and when they are, care must be taken to control, so far as is possible, those variables that influence PRA, such as physical activity, normal diurnal variations, drugs (eg, estrogens, diuretics, and antihypertensive agents), and sodium intake. Laragh et al recommend that blood be drawn at the same time of day (noon), after the patient has been ambulatory for several hours, and that the urinary sodium excretion for the previous 24 hours be measured to estimate the state of sodium balance. Does the information provided by a renin-sodium profile justify this meticulous attention to detail and the

REFERENCES

1 +
Laragh JH, Letcher RL, Pickering TG:  Renin profiling for diagnosis and treatment of hypertension . JAMA 241:151-156, 1979;.
2 +
Meyer P, Ecoiffier J, Alexandre JM, et al:  Prognostic value of plasma renin activity in renovascular hypertension . Circulation 36:570-576, 1967;.
3 +
Amsterdam EA, Couch NP, Christlieb R, et al:  Renal vein renin activity in the prognosis of surgery for renovascular hypertension . Am J Med 47:860-868, 1969;.
4 +
Hussain RA, Gifford RW Jr, Stewart BH, et al:  Differential renal venous renin activity in diagnosis of renovascular hypertension: Review of 29 cases . Am J Cardiol 32:707-715, 1973;.
5 +
Tucker RM, Strong CG, Brennan LA Jr, et al:  Renovascular hypertension: Relationship of surgical curability to renin angiotensin activity . Mayo Clin Proc 53:373-377, 1978;.
6 +
Brunner HR, Laragh JH, Baer L, et al:  Essential hypertension: Renin and aldosterone, heart attack and stroke . N Engl J Med 286:441-449, 1972;.
7 +
Kaplan NM:  The prognostic implications of plasma renin in essential hypertension . JAMA 231:167-170, 1975;.
8 +
Buhler FR, Laragh JH, Baer L, et al:  Propranolol inhibition of renin secretion . N Engl J Med 287:1209-1214, 1972;.
9 +
Esler M, Julius S, Zweifler A, et al:  Mild high-renin essential hypertension . N Engl J Med 296:405-411, 1977;.
10 +
DeQuattro V, Barbour BH, Campese V, et al:  Sympathetic nerve hyperactivity in high-renin hypertension: Effects of saralasin infusion . Mayo Clin Proc 52:369-373, 1977;.
11 +
Case DB, Wallace JM, Keim HJ, et al:  Estimating renin participation in hypertension: Superiority of converting enzyme inhibitor over saralasin . Am J Med 61:790-796, 1976;.
12 +
Morgan TO, Roberts R, Carney SL, et al:  β-Adrenergic receptor blocking drugs, hypertension and plasma renin . Br J Clin Pharmacol 2:159-164, 1975;.
13 +
Bravo EL, Tarazi RC, Dustan HP:  β-Adrenergic blockade in diuretictreated patients with essential hypertension . N Engl J Med 292:66-70, 1975;.
14 +
Bravo EL, Tarazi RC, Dustan HP:  On the mechanism of suppressed plasma-renin activity during β-adrenergic blockade with propranolol . J Lab Clin Med 83:119-128, 1974;.
15 +
Lionetti G, Mayer G, Morganti A, et al:  Hypotensive and renin-suppressing activities of propranolol in hypertensive patients . Clin Sci Mol Med 48:491-499, 1975;.
16 +
Hollifield JW, Sherman K, Vander Zwagg R, et al:  Proposed mechanisms of propranolol's antihypertensive effect in essential hypertension . N Engl J Med 295:68-73, 1976;.
17 +
Bravo EL, Tarazi RC, Dustan HP, et al:  Dissociation between renin and arterial pressure responses to beta-adrenergic blockade in human essential hypertension . Circ Res 36,37:241-247, 1975;.
18 +
Stokes GS, Weber MA, Smith JV, et al:  Double-blind crossover study of propranolol and spironolactone in hypertension and plasma renin measurements in relation to therapeutic effects , in Sambhi MP (ed): Antihypertensive Agents . New York, Stratton International Medical Book Corp, 1975;, pp 265-284.
19 +
Woods JM, Pittman AW, Pulliam CC, et al:  Renin profiling in hypertension and its use in treatment with propranolol and chlorthalidone . N Engl J Med 294:1137-1143, 1976;.
20 +
Zweifler A, Esler M:  Blood pressure, renin activity and heart rate changes during propranolol therapy of hypertension . Am J Cardiol 40:105-109, 1977;.

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1 +
Laragh JH, Letcher RL, Pickering TG:  Renin profiling for diagnosis and treatment of hypertension . JAMA 241:151-156, 1979;.
2 +
Meyer P, Ecoiffier J, Alexandre JM, et al:  Prognostic value of plasma renin activity in renovascular hypertension . Circulation 36:570-576, 1967;.
3 +
Amsterdam EA, Couch NP, Christlieb R, et al:  Renal vein renin activity in the prognosis of surgery for renovascular hypertension . Am J Med 47:860-868, 1969;.
4 +
Hussain RA, Gifford RW Jr, Stewart BH, et al:  Differential renal venous renin activity in diagnosis of renovascular hypertension: Review of 29 cases . Am J Cardiol 32:707-715, 1973;.
5 +
Tucker RM, Strong CG, Brennan LA Jr, et al:  Renovascular hypertension: Relationship of surgical curability to renin angiotensin activity . Mayo Clin Proc 53:373-377, 1978;.
6 +
Brunner HR, Laragh JH, Baer L, et al:  Essential hypertension: Renin and aldosterone, heart attack and stroke . N Engl J Med 286:441-449, 1972;.
7 +
Kaplan NM:  The prognostic implications of plasma renin in essential hypertension . JAMA 231:167-170, 1975;.
8 +
Buhler FR, Laragh JH, Baer L, et al:  Propranolol inhibition of renin secretion . N Engl J Med 287:1209-1214, 1972;.
9 +
Esler M, Julius S, Zweifler A, et al:  Mild high-renin essential hypertension . N Engl J Med 296:405-411, 1977;.
10 +
DeQuattro V, Barbour BH, Campese V, et al:  Sympathetic nerve hyperactivity in high-renin hypertension: Effects of saralasin infusion . Mayo Clin Proc 52:369-373, 1977;.
11 +
Case DB, Wallace JM, Keim HJ, et al:  Estimating renin participation in hypertension: Superiority of converting enzyme inhibitor over saralasin . Am J Med 61:790-796, 1976;.
12 +
Morgan TO, Roberts R, Carney SL, et al:  β-Adrenergic receptor blocking drugs, hypertension and plasma renin . Br J Clin Pharmacol 2:159-164, 1975;.
13 +
Bravo EL, Tarazi RC, Dustan HP:  β-Adrenergic blockade in diuretictreated patients with essential hypertension . N Engl J Med 292:66-70, 1975;.
14 +
Bravo EL, Tarazi RC, Dustan HP:  On the mechanism of suppressed plasma-renin activity during β-adrenergic blockade with propranolol . J Lab Clin Med 83:119-128, 1974;.
15 +
Lionetti G, Mayer G, Morganti A, et al:  Hypotensive and renin-suppressing activities of propranolol in hypertensive patients . Clin Sci Mol Med 48:491-499, 1975;.
16 +
Hollifield JW, Sherman K, Vander Zwagg R, et al:  Proposed mechanisms of propranolol's antihypertensive effect in essential hypertension . N Engl J Med 295:68-73, 1976;.
17 +
Bravo EL, Tarazi RC, Dustan HP, et al:  Dissociation between renin and arterial pressure responses to beta-adrenergic blockade in human essential hypertension . Circ Res 36,37:241-247, 1975;.
18 +
Stokes GS, Weber MA, Smith JV, et al:  Double-blind crossover study of propranolol and spironolactone in hypertension and plasma renin measurements in relation to therapeutic effects , in Sambhi MP (ed): Antihypertensive Agents . New York, Stratton International Medical Book Corp, 1975;, pp 265-284.
19 +
Woods JM, Pittman AW, Pulliam CC, et al:  Renin profiling in hypertension and its use in treatment with propranolol and chlorthalidone . N Engl J Med 294:1137-1143, 1976;.
20 +
Zweifler A, Esler M:  Blood pressure, renin activity and heart rate changes during propranolol therapy of hypertension . Am J Cardiol 40:105-109, 1977;.

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