RENIN-ANGIOTENSIN PROFILE AND COMPARATIVE EFFECTIVENESS OF FIRST-LINE MEDICATIONS IN MONOTHERAPY OF ESSENTIAL ARTERIAL HYPERTENSION

Abstract

The study investigated the rational antihypertensive therapy in 966 patients with essential arterial hypertension (AH) and various renin-angiotensin blood profiles. Mean age was 51,4±10,2 years, mean systolic blood pressure (SBP) – 193,3±7,4 mm Hg, and mean diastolic BP (DBP) – 113,3± 4,8 mm Hg. Plasma renin activity (PRA; normal levels 1,0-3,0 ng/ml/h) and plasma aldosterone concentration (PAC; normal levels 5-23 ng/dl) were measured by radio-immune methods. The normal ratio of PAC (ng/dl) to PRA (ng/ml/h) is 5-23. It was demonstrated that in patients with PRA<0,22 ng/ml/h, the main monotherapy medications were angiotensin II receptor antagonists (ARA) and angiotensin-converting enzyme inhibitors (ACEI). In patients with PRA 0,22-1,0 ng/ml/h and PAC: PRA ratio 5-23, the main monotherapy medications were calcium antagonists (CA) and hydrochlorothiazide; in patients with PAC: PRA ratio >< 0,22 ng/ml/h, the main monotherapy medications were angiotensin II receptor antagonists (ARA) and angiotensin-converting enzyme inhibitors (ACEI). In patients with PRA 0,22-1,0 ng/ml/h and PAC: PRA ratio 5-23, the main monotherapy medications were calcium antagonists (CA) and hydrochlorothiazide; in patients with PAC: PRA ratio >23 – ACEI and ARA; in patients with PRA 1,0-3,0 mg/ml/h and normoaldosteronism – CA; in patients with PRA >3,0 ng/ml/h and PAC: PRA ratio< 5 – beta-adrenoblockers.

Keywords

• renin
• aldosterone
• hydrochlorothiazide
• enalapril
• losartan
• atenolol
• nifedipine retard