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Hirooka K, Higashide T, Sakaguchi K, Udagawa S, Sugiyama K, Oki K, Kometani M, Yoneda T, Fukunaga K, Akita T, Baba T, Kiuchi Y. Prevalence of Normal-Tension Glaucoma in Patients With Primary Aldosteronism. Am J Ophthalmol 2024; 269:339-345. [PMID: 39284484 DOI: 10.1016/j.ajo.2024.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 09/05/2024] [Accepted: 09/09/2024] [Indexed: 10/10/2024]
Abstract
PURPOSE To investigate patients with primary aldosteronism (PA) and the prevalence of normal-tension glaucoma (NTG). DESIGN Cross-sectional study. METHODS Newly diagnosed PA patients were evaluated in this cross-sectional study, with ophthalmic examinations such as intraocular pressure measurements by a Goldmann applanation tonometer, central corneal thickness, slit-lamp biomicroscopic examination, gonioscopy, ophthalmoscopy, fundus photography, visual field test with a Humphrey Field Analyzer 24-2 SITA Standard program, and optical coherence tomography of the peripapillary retinal nerve fiber layer, performed in each of the subjects. Optic disc appearance, perimetric results, optical coherence tomography results, and other ocular findings were all used for determining the glaucoma diagnosis. The primary outcome was shown the prevalence of NTG in patients with PA. RESULTS NTG prevalence in the 212 PA patients was 11.8% (95% confidence interval [CI], 4.7%-20.7%). As compared to the hypertensive patients without PA, the hypertensive patients with PA exhibited a significantly increased NTG prevalence (odds ratio; 4.019, 95% CI, 1.223-13.205; P = .022). Increased NTG prevalence was associated with age, ranging from 8.8% (95% CI, 2.1%-15.6%) for those aged 40 to 49 years, to 37.5% (95% CI, 13.8%-61.2%) for those aged 70 years and older. In 72 hypertensive patients without PA, who were used as the controls, NTG prevalence was 5.2%, with a 95% CI ranging from 0.5% to 14.4%. CONCLUSIONS There was an 11.8% prevalence of NTG in PA patients, with these patients at an elevated risk of NTG, which was not mediated by blood pressure.
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Affiliation(s)
- Kazuyuki Hirooka
- From the Department of Ophthalmology and Visual Science, (K.H., T.B., Y.K.), Hiroshima University, Hiroshima, Japan.
| | - Tomomi Higashide
- Department of Ophthalmology (T.H., K.S., S.U., K.S.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kimikazu Sakaguchi
- Department of Ophthalmology (T.H., K.S., S.U., K.S.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Sachiko Udagawa
- Department of Ophthalmology (T.H., K.S., S.U., K.S.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuhisa Sugiyama
- Department of Ophthalmology (T.H., K.S., S.U., K.S.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kenji Oki
- Department of Molecular and Internal Medicine, (K.O.), Hiroshima University, Hiroshima, Japan
| | - Mitsuhiro Kometani
- Department of Health Promotion and Medicine of the Future (M.K., T.Y.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takashi Yoneda
- Department of Health Promotion and Medicine of the Future (M.K., T.Y.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kensaku Fukunaga
- Department of Endocrinology and Metabolism (K.F.), Kagawa University, Kagawa, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Diseases Control and Prevention (T.A.), Hiroshima University, Hiroshima, Japan
| | - Taro Baba
- From the Department of Ophthalmology and Visual Science, (K.H., T.B., Y.K.), Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- From the Department of Ophthalmology and Visual Science, (K.H., T.B., Y.K.), Hiroshima University, Hiroshima, Japan
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Arfsten H, Heitzinger G, Prausmüller S, Weidenhammer A, Goliasch G, Bartko PE, Spinka G, Hülsmann M, Pavo N. Excess renin is attributed to the combination of forward and backward failure in HFrEF. ESC Heart Fail 2024; 11:1748-1757. [PMID: 38459668 PMCID: PMC11098628 DOI: 10.1002/ehf2.14731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/05/2024] [Accepted: 02/06/2024] [Indexed: 03/10/2024] Open
Abstract
AIMS Regulation of the renin-angiotensin system (RAS) in heart failure (HF) with reduced ejection fraction (HFrEF) still raises questions, as a large proportion of patients show normal renin levels despite manifest disease. Experimental venous congestion results in reduced renal perfusion pressure and stimulates renin secretion. We hypothesized that excess renin levels are mainly a result of right ventricular failure as a sequalae of left ventricular dysfunction. The study aimed to link right ventricular function (RVF) with renin levels and to investigate further contributors to excess RAS activation. METHODS AND RESULTS Three hundred thirty-two chronic HFrEF patients undergoing routine ambulatory care were consecutively enrolled in a prospective, registry-based, observational study. Laboratory parameters, including cardiac-specific markers renin, aldosterone, and N-terminal pro-brain natriuretic peptide (NT-proBNP), echocardiographic examination (n = 247), and right heart catheterization (n = 85), were documented. The relationship between renin and its respective parameters was analysed. Renin concentration was not associated with the New York Heart Association class or NT-proBNP. Systolic blood pressure, systemic vascular resistance, serum sodium, aldosterone, and lactate dehydrogenase were associated with increased renin levels (P < 0.035 for all). Renin levels similarly increased with worsening of RVF parameters such as fractional area change, tricuspid annular plane systolic excursion, tissue Doppler imaging, and inferior vena cava diameter (P < 0.011 for all), but not with pulmonary pressure. Excess renin levels were observed when worsening RVF was combined with reduced renal perfusion {625 μIU/mL [interquartile range (IQR): 182-1761] vs. 67 μIU/mL [IQR: 16-231], P < 0.001}, which was associated with worse survival. CONCLUSIONS While unrelated to classical indices of HF severity, circulating renin levels increase with the worsening of RVF, especially in the combined presence of forward and backward failure. This might explain normal renin levels in HFrEF patients but also excess renin levels in poor haemodynamic conditions.
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Affiliation(s)
- Henrike Arfsten
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaWaehringer Guertel 18‐201090ViennaAustria
| | - Gregor Heitzinger
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaWaehringer Guertel 18‐201090ViennaAustria
| | - Suriya Prausmüller
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaWaehringer Guertel 18‐201090ViennaAustria
| | - Annika Weidenhammer
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaWaehringer Guertel 18‐201090ViennaAustria
| | - Georg Goliasch
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaWaehringer Guertel 18‐201090ViennaAustria
| | - Philipp E. Bartko
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaWaehringer Guertel 18‐201090ViennaAustria
| | - Georg Spinka
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaWaehringer Guertel 18‐201090ViennaAustria
| | - Martin Hülsmann
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaWaehringer Guertel 18‐201090ViennaAustria
| | - Noemi Pavo
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaWaehringer Guertel 18‐201090ViennaAustria
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Han E, Prausmüller S, Weidenhammer A, Spinka G, Arfsten H, Bartko PE, Goliasch G, Hülsmann M, Pavo N. Renin Trajectories and Outcome in Stable Heart Failure with Reduced Ejection Fraction (HFrEF) on Contemporary Therapy: A Monocentric Study from an Austrian Tertiary Hospital Outpatient Clinic. J Renin Angiotensin Aldosterone Syst 2023; 2023:8883145. [PMID: 37941680 PMCID: PMC10630017 DOI: 10.1155/2023/8883145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction The renin-angiotensin system (RAS) is the main target of neurohumoral therapy in heart failure with reduced ejection fraction (HFrEF) effectively reducing mortality. Reasonably, renin might serve as a biomarker for risk prediction and therapy response. Renin indeed bears some additional value to clinical risk models, albeit the effect is not pronounced. Whether assessing renin trajectories can overcome the weaknesses of single renin measurements has not been reported. Methods A total of 505 patients with stable HFrEF were enrolled prospectively and followed through routine clinical visits. Active plasma renin concentration was documented up to 5 years. Changes in renin were analyzed throughout the disease course, and survival was compared for different renin trajectories within the first year. Results Baseline renin levels were not related to all-cause mortality (crude HR for an increase of 100 μiE/ml: 1.01 (95% CI: 0.99-1.02), p = 0.414) but associated with unplanned HF hospitalizations (crude HR: 1.01 (95% CI: 1.00-1.02), p = 0.015). Renin increased during the disease course from baseline to 1-year and 2-year FUP (122.7 vs. 185.6 μIU/ml, p = 0.039, and 122.7 vs. 258.5 μIU/ml, p = 0.001). Both survival and unplanned HF hospitalization rates were comparable for different renin trajectories at 1-year FUP (p = 0.546, p = 0.357). Conclusions Intriguingly, renin is not a good biomarker to indicate prognosis in HF, while renin trajectories over a 1-year period do not have an additional value. Rapid physiologic plasma renin variations, but also opposing effects of angiotensinogen-derived metabolites under presence of RAS blockade, might obscure the predictive ability of renin.
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Affiliation(s)
- Emilie Han
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Suriya Prausmüller
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Annika Weidenhammer
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Spinka
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Henrike Arfsten
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Philipp E. Bartko
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Noemi Pavo
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
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Deja A, Skrzypczyk P, Nowak M, Wrońska M, Szyszka M, Ofiara A, Lesiak-Kosmatka J, Stelmaszczyk-Emmel A, Pańczyk-Tomaszewska M. Evaluation of Active Renin Concentration in A Cohort of Adolescents with Primary Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105960. [PMID: 35627493 PMCID: PMC9141058 DOI: 10.3390/ijerph19105960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022]
Abstract
Our study aimed to assess active renin concentration in children with primary hypertension. Thus, we evaluated active renin concentration, clinical parameters, office and ambulatory blood pressure, and biochemical parameters in 51 untreated adolescents with primary hypertension (median: 14.4 [interquartile range—IQR: 13.8–16.8] years) and 45 healthy adolescents. Active renin concentration did not differ between patients with hypertension and healthy children (median: 28.5 [IQR: 21.9–45.2] vs. 24.9 [IQR: 16.8–34.3] [pg/mL], p = 0.055). In the whole group of 96 children, active renin concentration correlated positively with serum potassium and office and ambulatory systolic and diastolic blood pressures. Among children with hypertension, patients with isolated systolic hypertension had lower renin concentration than patients with systolic-diastolic hypertension (26.2 [IQR: 18.6–34.2] vs. 37.8 [IQR: 27.0–49.6] [pg/mL], p = 0.014). The active renin concentration did not differ between patients with isolated systolic hypertension and healthy children. In multivariate analysis, diastolic blood pressure Z-score (beta = 0.238, 95 confidence interval [0.018–0.458], p = 0.035) was the only predictor of active renin concentration in the studied children. We concluded that active renin concentration is positively associated with blood pressure and potassium in children, and diastolic blood pressure was the strongest predictor of renin level. Patients with isolated systolic hypertension may differ from patients with systolic-diastolic hypertension in less severe activation of the renin-angiotensin-aldosterone system.
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Affiliation(s)
- Anna Deja
- Department of Pediatrics and Nephrology, Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.D.); (M.S.)
| | - Piotr Skrzypczyk
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.O.); (M.P.-T.)
- Correspondence: ; Tel.: +48-22-317-96-53; Fax: +48-22-317-99-54
| | - Magdalena Nowak
- Student Scientific Group, Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.N.); (M.W.)
| | - Małgorzata Wrońska
- Student Scientific Group, Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.N.); (M.W.)
| | - Michał Szyszka
- Department of Pediatrics and Nephrology, Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.D.); (M.S.)
| | - Anna Ofiara
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.O.); (M.P.-T.)
| | - Justyna Lesiak-Kosmatka
- Student Scientific Group, Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Anna Stelmaszczyk-Emmel
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, 02-091 Warsaw, Poland;
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Neurohumoral, cardiac and inflammatory markers in the evaluation of heart failure severity and progression. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:47-66. [PMID: 33613659 PMCID: PMC7868913 DOI: 10.11909/j.issn.1671-5411.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Heart failure is common in adult population, accounting for substantial morbidity and mortality worldwide. The main risk factors for heart failure are coronary artery disease, hypertension, obesity, diabetes mellitus, chronic pulmonary diseases, family history of cardiovascular diseases, cardiotoxic therapy. The main factor associated with poor outcome of these patients is constant progression of heart failure. In the current review we present evidence on the role of established and candidate neurohumoral biomarkers for heart failure progression management and diagnostics. A growing number of biomarkers have been proposed as potentially useful in heart failure patients, but not one of them still resembles the characteristics of the “ideal biomarker.” A single marker will hardly perform well for screening, diagnostic, prognostic, and therapeutic management purposes. Moreover, the pathophysiological and clinical significance of biomarkers may depend on the presentation, stage, and severity of the disease. The authors cover main classification of heart failure phenotypes, based on the measurement of left ventricular ejection fraction, including heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, and the recently proposed category heart failure with mid-range ejection fraction. One could envisage specific sets of biomarker with different performances in heart failure progression with different left ventricular ejection fraction especially as concerns prediction of the future course of the disease and of left ventricular adverse/reverse remodeling. This article is intended to provide an overview of basic and additional mechanisms of heart failure progression will contribute to a more comprehensive knowledge of the disease pathogenesis.
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Ikeda Y, Tsutsui K, Yamada Y, Kato R, Muramatsu T, Senbonmatsu T. Relationship between Soluble (pro)Renin Receptor and Renin Activity in Patients with Severe Heart Failure. J Clin Med 2020; 9:E4110. [PMID: 33352807 PMCID: PMC7765833 DOI: 10.3390/jcm9124110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
The (pro)renin receptor ((P)RR), which evokes renin activity with prorenin, is secreted extracellularly as soluble (P)RR (s(P)RR) and may participate in tissue renin-angiotensin system (RAS) activity in severe heart failure (HF) patients. The aim of this study was to determine whether s(P)RR is an adequate marker in severe HF patients treated with RAS inhibitors, beta-blockers, and tolvaptan. We enrolled 11 patients with severe HF between May 2013 and June 2014. First of all, furosemide of all patients was changed to tolvaptan with hydrochlorothiazide and then the treatment had been changed according to the patient's condition. After 1, 3, 6, and 12 months, the variance of s(P)RR, plasma renin activity (PRA), plasma renin concentration (PRC), brain natriuretic peptide (BNP) and their association was investigated. Furosemide was restarted in five patients and two patients suffered cardiac death. PRA/PRC and s(P)RR were unchanged (PRA: 10.7 ± 13.9 to 12.8 ± 8.5 ng/mL/h; PRC: 347.1 ± 577.5 to 148.3 ± 123.8 pg/mL; s(P)RR: 28.2 ± 19.3 to 33.4 ± 22.4 ng/mL) and had no significant correlations (PRA and s(P)RR: p = 0.36; PRC and s(P)RR: p = 0.35). There was a significant positive correlation with a high correlation coefficient (CC) between PRA and PRC (p < 0.0001, CC = 0.76), and a negative correlation with weak CC between BNP and s(P)RR (p = 0.01, CC = -0.45). In conclusion, s(P)RR was always high and had no correlations with disease state and PRA/PRC in severe HF patients.
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Affiliation(s)
- Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; (K.T.); (Y.Y.); (R.K.); (T.M.); (T.S.)
| | - Kenta Tsutsui
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; (K.T.); (Y.Y.); (R.K.); (T.M.); (T.S.)
| | - Yoshihiro Yamada
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; (K.T.); (Y.Y.); (R.K.); (T.M.); (T.S.)
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; (K.T.); (Y.Y.); (R.K.); (T.M.); (T.S.)
| | - Toshihiro Muramatsu
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; (K.T.); (Y.Y.); (R.K.); (T.M.); (T.S.)
| | - Takaaki Senbonmatsu
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; (K.T.); (Y.Y.); (R.K.); (T.M.); (T.S.)
- Department, Research Administration Center, Saitama Medical University, Saitama 350-1298, Japan
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Kobayashi M, Stienen S, Ter Maaten JM, Dickstein K, Samani NJ, Lang CC, Ng LL, Anker SD, Metra M, Preud'homme G, Duarte K, Lamiral Z, Girerd N, Rossignol P, van Veldhuisen DJ, Voors AA, Zannad F, Ferreira JP. Clinical determinants and prognostic implications of renin and aldosterone in patients with symptomatic heart failure. ESC Heart Fail 2020; 7:953-963. [PMID: 32167681 PMCID: PMC7261568 DOI: 10.1002/ehf2.12634] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/26/2019] [Accepted: 01/14/2020] [Indexed: 12/17/2022] Open
Abstract
Aims Activation of the renin–angiotensin–aldosterone system plays an important role in the pathophysiology of heart failure (HF) and has been associated with poor prognosis. There are limited data on the associations of renin and aldosterone levels with clinical profiles, treatment response, and study outcomes in patients with HF. Methods and results We analysed 2,039 patients with available baseline renin and aldosterone levels in BIOSTAT‐CHF (a systems BIOlogy study to Tailored Treatment in Chronic Heart Failure). The primary outcome was the composite of all‐cause mortality or HF hospitalization. We also investigated changes in renin and aldosterone levels after administration of mineralocorticoid receptor antagonists (MRAs) in a subset of the EPHESUS trial and in an acute HF cohort (PORTO). In BIOSTAT‐CHF study, median renin and aldosterone levels were 85.3 (percentile25–75 = 28–247) μIU/mL and 9.4 (percentile25–75 = 4.4–19.8) ng/dL, respectively. Prior HF admission, lower blood pressure, sodium, poorer renal function, and MRA treatment were associated with higher renin and aldosterone. Higher renin was associated with an increased rate of the primary outcome [highest vs. lowest renin tertile: adjusted‐HR (95% CI) = 1.47 (1.16–1.86), P = 0.002], whereas higher aldosterone was not [highest vs. lowest aldosterone tertile: adjusted‐HR (95% CI) = 1.16 (0.93–1.44), P = 0.19]. Renin and/or aldosterone did not improve the BIOSTAT‐CHF prognostic models. The rise in aldosterone with the use of MRAs was observed in EPHESUS and PORTO studies. Conclusions Circulating levels of renin and aldosterone were associated with both the disease severity and use of MRAs. By reflecting both the disease and its treatments, the prognostic discrimination of these biomarkers was poor. Our data suggest that the “point” measurement of renin and aldosterone in HF is of limited clinical utility.
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Affiliation(s)
- Masatake Kobayashi
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Susan Stienen
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Jozine M Ter Maaten
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kenneth Dickstein
- Department of Internal Medicine, University of Bergen, Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin, Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin Berlin, Germany
| | - Macro Metra
- Department of Cardiology, University and Civil hospitals of Brescia, Brescia, Italy
| | - Gregoire Preud'homme
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Kevin Duarte
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Zohra Lamiral
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Patrick Rossignol
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - João Pedro Ferreira
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
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Rachwan RJ, Butler J, Collins SP, Cotter G, Davison BA, Senger S, Ezekowitz JA, Filippatos G, Levy PD, Metra M, Ponikowski P, Teerlink JR, Voors AA, de Boer RA, Soergel DG, Felker GM, Pang PS. Is plasma renin activity associated with worse outcomes in acute heart failure? A secondary analysis from the BLAST-AHF trial. Eur J Heart Fail 2019; 21:1561-1570. [PMID: 31646707 DOI: 10.1002/ejhf.1607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Neurohormonal activation characterizes chronic heart failure (HF) and is a well-established therapeutic target. Neurohormonal activation may also play a key role in acute HF (AHF). We aim to describe the association between plasma renin activity (PRA) and three AHF outcomes: (i) worsening HF or death through day 5 of hospitalization; (ii) HF rehospitalization or death through day 30; and (iii) all-cause death through day 30. METHODS AND RESULTS A secondary analysis of the BLAST-AHF trial was performed. Eligible patients had a history of HF, elevated natriuretic peptides, signs and symptoms of HF, systolic blood pressure >120 mmHg, and an estimated glomerular filtration rate between 20-75 mL/min/1.73 m2 . The primary trial was neutral, with no differential effect of study drug by PRA levels. Baseline PRA levels were grouped into tertiles. Adjusted Cox proportional hazard model determined the association of PRA levels with outcomes (α set at P < 0.05). Of 618 randomized patients, 578 (93.5%) had a baseline PRA. PRA was modestly, but significantly, associated with each outcome without adjustment [worsening HF or death through day 5: hazard ratio (HR) 1.11, 95% confidence interval (CI) 1.01-1.23, P = 0.04; HF rehospitalization or death through day 30: HR 1.13, 95% CI 1.02-1.26, P = 0.02; all-cause death through day 30: HR 1.18, 95% CI 1.02-1.37, P = 0.03]. After multivariable adjustment, PRA was only significantly associated with HF rehospitalization or death through day 30 (HR 1.15, 95% CI 1.01-1.32, P = 0.04). CONCLUSION Baseline PRA levels are associated with increased risk for the composite of 30-day HF rehospitalization or death in patients with AHF.
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Affiliation(s)
- Rayan Jo Rachwan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Javed Butler
- SUNY Stonybrook School of Medicine, New York, NY, USA
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | | | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Phillip D Levy
- Wayne State University School of Medicine and Cardiovascular Research Institute, Detroit, MI, USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - David G Soergel
- Cardiovascular and Metabolic Diseases, Novartis Pharmaceuticals, East Hanover, NJ, USA
| | - G Michael Felker
- Duke University School of Medicine and the Duke Clinical Research Institute, Durham, NC, USA
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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9
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Renin Activity in Heart Failure with Reduced Systolic Function-New Insights. Int J Mol Sci 2019; 20:ijms20133182. [PMID: 31261774 PMCID: PMC6651297 DOI: 10.3390/ijms20133182] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/27/2022] Open
Abstract
Regardless of the cause, symptomatic heart failure (HF) with reduced ejection fraction (rEF) is characterized by pathological activation of the renin–angiotensin–aldosterone system (RAAS) with sodium retention and extracellular fluid expansion (edema). Here, we review the role of active renin, a crucial, upstream enzymatic regulator of the RAAS, as a prognostic and diagnostic plasma biomarker of heart failure with reduced ejection fraction (HFrEF) progression; we also discuss its potential as a pharmacological bio-target in HF therapy. Clinical and experimental studies indicate that plasma renin activity is elevated with symptomatic HFrEF with edema in patients, as well as in companion animals and experimental models of HF. Plasma renin activity levels are also reported to be elevated in patients and animals with rEF before the development of symptomatic HF. Modulation of renin activity in experimental HF significantly reduces edema formation and the progression of systolic dysfunction and improves survival. Thus, specific assessment and targeting of elevated renin activity may enhance diagnostic and therapeutic precision to improve outcomes in appropriate patients with HFrEF.
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10
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Pavo N, Goliasch G, Wurm R, Novak J, Strunk G, Gyöngyösi M, Poglitsch M, Säemann MD, Hülsmann M. Low- and High-renin Heart Failure Phenotypes with Clinical Implications. Clin Chem 2018; 64:597-608. [DOI: 10.1373/clinchem.2017.278705] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 10/23/2017] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Blockade of the renin–angiotensin system (RAS) represents a main strategy in the therapy of heart failure with reduced ejection fraction (HFrEF), but the role of active renin concentration (ARC) for guiding therapy in the presence of an RAS blockade remains to be established. This study assessed angiotensin profiles of HFrEF patients with distinct RAS activations as reflected by ARC.
METHODS
Two cohorts of stable chronic HFrEF patients on optimal medical treatment (OMT) were enrolled. We assessed ARC and all known circulating angiotensin metabolites, including AngI and AngII, by mass spectrometry to investigate the effect of different therapy modalities. Low- and high-renin HFrEF patients were identified by ARC screening and subsequently characterized by their angiotensin profiles.
RESULTS
Although different modes of RAS blockade resulted in typical AngII/AngI ratios, concentrations of (AngI+AngII) strongly correlated with ARC [r = 0.95, P < 0.001] independent of therapy mode. Despite RAS blocker treatment with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II type 1 receptor blockers (ARB), which anticipated ARC upregulation, about 30% of patients showed lower/normal range ARC values. ARC did not correlate with N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations and New York Heart Association (NYHA) stages. Angiotensin concentrations were profoundly diminished for the low-ARC group compared with the high-ARC group: AngI [6.4 ng/L (IQR: 2.1–12.5) vs 537.9 ng/L (IQR: 423.1–728.4), P < 0.001 for ACE-I; and 4.5 ng/L (IQR: 1.4–11.2) vs 203.0 ng/L (IQR: 130.2–247.9), P = 0.003 for ARB] and AngII [<1.4 ng/L (IQR: <1.4–1.5) vs 6.1 ng/L (IQR: 2.0–11.1), P = 0.002 for ACE-I and 4.7 ng/L (IQR: <1.4–12.3) vs 206.4 ng/L (IQR: 142.2–234.4), P < 0.001 for ARB].
CONCLUSIONS
In addition to NT-proBNP and NYHA stages, ARC enables classification of HFrEF patients receiving OMT into more distinguished neurohumoral HFrEF phenotypes, offering a rationale for adaptive therapeutic interventions.
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Affiliation(s)
- Noemi Pavo
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Raphael Wurm
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Johannes Novak
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Guido Strunk
- Complexity Research, Vienna, Austria; FH Campus Vienna, Vienna, Austria, and Technical University Dortmund, Dortmund, Germany
| | - Mariann Gyöngyösi
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Marcus D Säemann
- Department of Internal Medicine III, Clinical Division of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
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11
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Vilela LAP, Almeida MQ. Diagnosis and management of primary aldosteronism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:305-312. [PMID: 28699986 PMCID: PMC10118808 DOI: 10.1590/2359-3997000000274] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 05/04/2017] [Indexed: 12/24/2022]
Abstract
Primary aldosteronism (PA) is the most common form of secondary hypertension (HTN), with an estimated prevalence of 4% of hypertensive patients in primary care and around 10% of referred patients. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential HTN and the same degree of blood pressure elevation. PA is characterized by an autonomous aldosterone production causing sodium retention, plasma renin supression, HTN, cardiovascular damage, and increased potassium excretion, leading to variable degrees of hypokalemia. Aldosterone-producing adenomas (APAs) account for around 40% and idiopathic hyperaldosteronism for around 60% of PA cases. The aldosterone-to-renin ratio is the most sensitive screening test for PA. There are several confirmatory tests and the current literature does not identify a "gold standard" confirmatory test for PA. In our institution, we recommend starting case confirmation with the furosemide test. After case confirmation, all patients with PA should undergo adrenal CT as the initial study in subtype testing to exclude adrenocortical carcinoma. Bilateral adrenal vein sampling (AVS) is the gold standard method to define the PA subtype, but it is not indicated in all cases. An experienced radiologist must perform AVS. Unilateral laparoscopic adrenalectomy is the preferential treatment for patients with APAs, and bilateral hyperplasia should be treated with mineralocorticoid antagonist (spironolactone or eplerenone). Cardiovascular morbidity caused by aldosterone excess can be decreased by either unilateral adrenalectomy or mineralocorticoid antagonist. In this review, we address the most relevant issues regarding PA screening, case confirmation, subtype classification, and treatment.
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Affiliation(s)
- Leticia A P Vilela
- Unidade de Suprarrenal, Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular - LIM42, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Madson Q Almeida
- Unidade de Suprarrenal, Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular - LIM42, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.,Instituto do Câncer do Estado de São Paulo (Icesp), FMUSP, São Paulo, SP, Brasil
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12
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Abstract
Hypertension is a major cardiovascular risk factor that affects between 10-40% of the general population in an age dependent manner. The renin-angiotensin-aldosterone system (RAAS) regulates blood pressure, fluid volume, and the vascular response to injury and inflammation 1. Chronic RAAS activation in the presence of sufficient sodium consumption leads to persistent hypertension, setting off a cascade of inflammatory, thrombotic, and atherogenic effects eventually leading to end-organ damage 2 3. Accordingly, numerous studies have demonstrated that elevated renin and/or aldosterone levels are predictors of adverse outcome in hypertension 4, heart failure 5 6, myocardial infarction 7, and renal insufficiency 8 and influence insulin resistance 9. Primary aldosteronism (PA) is the most common secondary form of hypertension with an estimated prevalence between 4 and 12% of hypertensives 10 11 12 and 11-20% in patients that are resistant to combined antihypertensive medication 13 14. Given the severe cardiovascular adverse effects of aldosterone excess that are independent of high blood pressure levels 15 16 17 18 detection and treatment of PA has important impact on clinical outcome and survival.
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Affiliation(s)
- M Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - F Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
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13
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Nakada Y, Takahama H, Kanzaki H, Sugano Y, Hasegawa T, Ohara T, Amaki M, Funada A, Yoshida A, Yasuda S, Ogawa H, Anzai T. The predictability of renin–angiotensin–aldosterone system factors for clinical outcome in patients with acute decompensated heart failure. Heart Vessels 2015; 31:925-31. [DOI: 10.1007/s00380-015-0688-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
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14
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Sato Y. Renin – A Historical Biomarker of Heart Failure –. Circ J 2015; 79:1206-8. [DOI: 10.1253/circj.cj-15-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki Hospital
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15
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Sim JJ, Shi J, Al-Moomen R, Behayaa H, Kalantar-Zadeh K, Jacobsen SJ. Plasma renin activity and its association with ischemic heart disease, congestive heart failure, and cerebrovascular disease in a large hypertensive cohort. J Clin Hypertens (Greenwich) 2014; 16:805-13. [PMID: 25255792 DOI: 10.1111/jch.12419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/21/2014] [Accepted: 08/24/2014] [Indexed: 12/24/2022]
Abstract
Plasma renin activity (PRA) may be a surrogate for vascular damage. The authors hypothesize that PRA is associated with cardiovascular and cerebrovascular disease (CED). A cross-sectional study (January 1, 1998, to December 31, 2009) was performed on hypertensive individuals 18 years and older using multivariable logistic regression models to estimate odds ratios (ORs) for ischemic heart disease (IHD), congestive heart failure (CHF), and CED based on PRA quartiles controlling for age, sex, race, diabetes mellitus (DM), and medication use. Among 7887 individuals (60% women; 34% whites, 23% blacks, and 19% Hispanics; and 29% with DM), the adjusted ORs (95% CI) for IHD were 0.94 (0.80-1.10), 1.09 (0.92-1.29), and 1.18 (1.00-1.39); for CHF were 1.23 (0.99-1.53), 1.27 (1.01-1.61), and 1.41 (1.13-1.77); and for CED were 0.95 (0.78-1.17), 0.77 (0.61-0.97), and 0.97 (0.78-1.20) for the second, third, and fourth quartiles compared with the first quartile. Higher PRA was associated with greater likelihood for prevalent IHD and CHF but not CED in this large ethnically diverse population of hypertensive individuals.
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Affiliation(s)
- John J Sim
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
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16
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Abstract
Arterial hypertension is a major cardiovascular risk factor that affects between 10 and 40% of the population in industrialized countries. Primary aldosteronism (PA) is the most common form of secondary hypertension with an estimated prevalence of around 10% in referral centers and 4% in a primary care setting. Despite its high prevalence until recently, the underlying genetic and molecular basis of this common disease had remained largely obscure. Over the past decade, a number of insights have been achieved that have relied on in vitro cellular systems, wild-type and genetically modified in vivo models, as well as clinical studies in well-characterized patient populations. This progress has been made possible by a number of independent technical developments including that of specific hormone assays that allow measurement in small sample volumes as well as genetic techniques that enable high-throughput sequencing of a large number of samples. Furthermore, animal models have provided important insights into the physiology of aldosterone regulation that have served as a starting point for investigation of mechanisms involved in autonomous aldosterone secretion. Finally, national and international networks that have built up registries and biobanks have been instrumental in fostering translational research endeavors in PA. Therefore, it is to be expected that in the near future, further pathophysiological mechanisms that result in autonomous aldosterone secretion will be unraveled.
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Affiliation(s)
- Felix Beuschlein
- Endocrine Research Unit, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstrasse 1, D-80336 Munich, Germany.
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17
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Abstract
The renin-angiotensin-aldosterone-system (RAAS) plays a central role in the pathophysiology of heart failure and cardiorenal interaction. Drugs interfering in the RAAS form the pillars in treatment of heart failure and cardiorenal syndrome. Although RAAS inhibitors improve prognosis, heart failure–associated morbidity and mortality remain high, especially in the presence of kidney disease. The effect of RAAS blockade may be limited due to the loss of an inhibitory feedback of angiotensin II on renin production. The subsequent increase in prorenin and renin may activate several alternative pathways. These include the recently discovered (pro-) renin receptor, angiotensin II escape via chymase and cathepsin, and the formation of various angiotensin subforms upstream from the blockade, including angiotensin 1–7, angiotensin III, and angiotensin IV. Recently, the direct renin inhibitor aliskiren has been proven effective in reducing plasma renin activity (PRA) and appears to provide additional (tissue) RAAS blockade on top of angiotensin-converting enzyme and angiotensin receptor blockers, underscoring the important role of renin, even (or more so) under adequate RAAS blockade. Reducing PRA however occurs at the expense of an increase plasma renin concentration (PRC). PRC may exert direct effects independent of PRA through the recently discovered (pro-) renin receptor. Additional novel possibilities to interfere in the RAAS, for instance using vitamin D receptor activation, as well as the increased knowledge on alternative pathways, have revived the question on how ideal RAAS-guided therapy should be implemented. Renin and prorenin are pivotal since these are at the base of all of these pathways.
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18
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Abstract
PURPOSE OF REVIEW This review examines the evidence that plasma renin and/or prorenin level may be used to guide therapy in hypertension and as an independent risk factor for future cardiovascular events. RECENT FINDINGS A large number of retrospective analyses of patient populations in clinical trials, in whom 'baseline' renin measurements were available, supports that high renin, but not high prorenin levels, are indicative of future cardiovascular disease and death, particularly in patients with kidney dysfunction and/or hypertension. The relationship is not affected by the use of renin-angiotensin system (RAS) blockers. High renin levels also tend to support the use of RAS inhibitors as first-choice antihypertensive agents. However, the added value of a renin measurement on top of traditional risk factors is modest, and the pressure response to RAS blockade, even in high-renin patients, varies widely. SUMMARY Measuring 'baseline' renin as a marker of future cardiovascular events or to determine the choice of drug is of limited value in an individual patient.
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19
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Daimon M, Konta T, Oizumi T, Karasawa S, Kaino W, Takase K, Jimbu Y, Wada K, Kameda W, Susa S, Saito T, Kubota I, Kayama T, Kato T. Higher plasma renin activity is a risk factor for total mortality in older Japanese individuals: the Takahata study. Metabolism 2012; 61:504-11. [PMID: 22001336 DOI: 10.1016/j.metabol.2011.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/10/2011] [Accepted: 08/17/2011] [Indexed: 01/18/2023]
Abstract
Plasma renin activity (PRA) is accepted as a marker for increased risk of cardiovascular diseases. However, the association between PRA and total mortality has not been fully explored in a general population. We here examined whether PRA is associated with increased total mortality in a general Japanese population. The participants of the Takahata study (3502 subjects; age, 62.5 ± 10.4 years), a population-based, longitudinal study of Japanese held from 2004 to 2006, were enrolled and followed up for up to 7 years. The incidence of death and causes of death were monitored annually to the end of 2010 (median follow-up, 2280 days). During the follow-up period, 143 subjects died. Kaplan-Meier analysis showed a significantly increased risk for total mortality in subjects with higher PRA (log-rank P < .001). Cox proportional hazard model analyses with adjustment for factors correlated with PRA (age, sex, weight, diastolic blood pressure, high-density lipoprotein cholesterol, uric acid, B-type natriuretic peptide, serum total protein, antihypertensive treatment, and diabetes) showed that higher PRA was associated with increased total mortality in linear regression models (per 1 increase in log 10 × PRA [nanograms per milliliter per hour]: hazard ratio, 2.12; 95% confidence interval, 1.47-3.06), between groups of patients stratified by quartiles of PRA (highest vs lowest quartile: 2.63, 1.57-4.41) and in subjects with high (≥ 2.0 ng/[mL h]) vs low (<2.0 ng/[mL h]) PRA (1.97, 1.37-2.83). Higher PRA was a significant and independent risk factor for increased total mortality in this Japanese population and may be a marker for subjects at an increased risk of total mortality.
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Affiliation(s)
- Makoto Daimon
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University School of Medicine, Yamagata, Japan.
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20
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Measuring and targeting aldosterone and renin in atherosclerosis-a review of clinical data. Am Heart J 2011; 162:585-96. [PMID: 21982648 DOI: 10.1016/j.ahj.2011.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 06/21/2011] [Indexed: 01/13/2023]
Abstract
Our understanding of the development and progression of atherosclerosis has increased substantially over the past decades. A significant role for the renin-angiotensin-aldosterone system (RAAS) in this process has gained appreciation in recent years. Preclinical and clinical studies have associated components of the RAAS with various cardiovascular disease conditions. Classically known for its contribution to hypertension, dysregulation of the system is now also believed to promote vascular inflammation, fibrosis, remodeling, and endothelial dysfunction, all intimately related to atherosclerosis. The reduction in cardiovascular mortality and morbidity, as seen with the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, supports the concept that RAAS is involved in the pathogenesis of atherosclerotic disease. However, the underlying molecular mechanisms of the pathophysiology remain to be completely understood. Evidence points toward additional benefit from therapeutic approaches aiming at more complete inhibition of the system and the possible utility of renin or aldosterone in the prediction of cardiovascular outcome. This review will summarize the current knowledge from clinical studies regarding the presumptive role of renin and aldosterone in the prediction and management of patients with atherosclerosis. For this purpose, a literature search was performed, focusing on available clinical data regarding renin or aldosterone and cardiovascular outcome.
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21
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Szymanski MK, Damman K, van Veldhuisen DJ, van Gilst WH, Hillege HL, de Boer RA. Prognostic value of renin and prorenin in heart failure patients with decreased kidney function. Am Heart J 2011; 162:487-93. [PMID: 21884865 DOI: 10.1016/j.ahj.2011.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 06/06/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND The renin-angiotensin-aldosterone system (RAAS) plays a key role in the progression of heart failure (HF) and concomitant kidney dysfunction. Despite the use of RAAS blockade, sustained activation of RAAS has been suggested to link with adverse outcome. We aimed to investigate the prognostic value of active plasma renin concentration (APRC) and prorenin in patients with HF treated with RAAS-blocking agents and its relationship with kidney function parameters. METHODS One hundred clinically stable patients with HF, treated with RAAS-blocking agents, were studied. Renal function parameters including effective renal plasma flow and glomerular filtration rate were measured invasively. The combined end point consisted of all-cause mortality, heart transplantation, and admission to hospital for HF. RESULTS Mean age was 58 ± 12 years, and 76% were men. Mean left ventricular ejection fraction was 28 ± 9, and median APRC levels were 24.3 ng/mL per hour. Active plasma renin concentration was most strongly associated with mean arterial pressure (r = 0.60, P < .001). In multivariate linear regression analysis, age, mean arterial pressure, angiotensin II concentration, and use of aldosterone antagonists were significantly related with APRC (adjusted R(2) = 0.53). Patients in the highest quartile of APRC had a worse prognosis. In multivariate analysis, APRC remained associated with worse prognosis: HR 2.87 (95% CI 1.14-7.20), P = .025. Prorenin did not show prognostic value. The prognostic value of APRC was strongest in patients with decreased kidney function. CONCLUSIONS Our data indicate that APRC is a strong prognostic factor in patients with HF in the presence of RAAS inhibition, especially in patients with kidney dysfunction.
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22
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Abstract
There is now clear evidence that reducing blood pressure (BP) with a broad range of agents, including angiotensin converting enzyme inhibitors and angiotensin receptor blockers, improves cardiovascular and renal outcomes. There is also evidence suggesting that these drugs have beneficial effects that are independent of BP lowering. Aliskiren is a direct renin inhibitor that interrupts the renin-angiotensin-aldosterone system (RAAS) at its rate-limiting step. Unlike angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, aliskiren produces a sustained reduction in plasma renin activity and reduces plasma levels of angiotensin II and aldosterone. Preclinical data and clinical trials in high-risk patients using surrogate markers increasingly suggest that aliskiren can reduce the progression of end-organ damage beyond that afforded by BP control. With its unique mechanism of action, combining aliskiren with another RAAS-blocking agent that has a different mechanism of action may provide more comprehensive blockade of the RAAS, potentially conferring additional clinical benefits. Evaluation of these end-organ effects in humans is underway in clinical trials designed to assess the effects of aliskiren alone and in combination with other antihypertensive agents on cardiovascular and renal outcomes.
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23
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Verma S, Gupta M, Holmes DT, Xu L, Teoh H, Gupta S, Yusuf S, Lonn EM. Plasma renin activity predicts cardiovascular mortality in the Heart Outcomes Prevention Evaluation (HOPE) study. Eur Heart J 2011; 32:2135-42. [DOI: 10.1093/eurheartj/ehr066] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Nishiyama K, Tsutamoto T, Kawahara C, Yamaji M, Sakai H, Yamamoto T, Fujii M, Horie M. Relationship Between Biological Variation in B-Type Natriuretic Peptide and Plasma Renin Concentration in Stable Outpatients With Dilated Cardiomyopathy. Circ J 2011; 75:1897-904. [DOI: 10.1253/circj.cj-10-1083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Keizo Nishiyama
- Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Takayoshi Tsutamoto
- Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Chiho Kawahara
- Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Masayuki Yamaji
- Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Hiroshi Sakai
- Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Takashi Yamamoto
- Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Masanori Fujii
- Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Minoru Horie
- Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
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25
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Masson S, Solomon S, Angelici L, Latini R, Anand IS, Prescott M, Maggioni AP, Tognoni G, Cohn JN. Elevated Plasma Renin Activity Predicts Adverse Outcome in Chronic Heart Failure, Independently of Pharmacologic Therapy: Data From the Valsartan Heart Failure Trial (Val-HeFT). J Card Fail 2010; 16:964-70. [DOI: 10.1016/j.cardfail.2010.06.417] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 06/11/2010] [Accepted: 06/29/2010] [Indexed: 10/19/2022]
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Comparison of the long-term effects of candesartan and olmesartan on plasma angiotensin II and left ventricular mass index in patients with hypertension. Hypertens Res 2009; 33:118-22. [PMID: 19927151 DOI: 10.1038/hr.2009.192] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In general, treatment with most angiotensin receptor blockers (ARBs) increases plasma angiotensin II (Ang II) level because of a lack of negative feedback on renin activity. Olmesartan is a potential ARB inducing activation of angiotensin-converting enzyme 2 (ACE2) that hydrolyzes Ang II to Ang 1-7, and has shown a beneficial effect on ventricular remodeling. Indeed, a previous study reported that olmesartan treatment resulted in decreased plasma levels of Ang II and aldosterone. However, there has not yet been a study showing the relationship of chronic effects of olmesartan on Ang II and the left ventricular mass index (LVMI) in comparison with those of other ARB.A total of 50 stable outpatients with essential hypertension who had received candesartan for more than 1 year were randomized into two groups: control group (n=25): continuous candesartan treatment at a stable dose; and olmesartan group (n=25): candesartan (8 mg day(-1)) was changed to olmesartan given at a dose of 20 mg day(-1). There was no difference in the baseline characteristics between the two groups. In the control group, there were no significant changes in blood pressure, LVMI or biomarkers during 12 months of study. In the olmesartan group, blood pressure did not change and plasma levels of Ang II decreased during 12 months of study, whereas LVMI was significantly decreased after 12 months (135+/-36 vs. 123+/-29 g m(-2); P<0.01).These findings indicate that replacing candesartan with olmesartan decreased LVMI in association with a sustained decrease of plasma Ang II over a 12-month period without changing blood pressure or plasma aldosterone in patients with essential hypertension.
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27
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Yamaji M, Tsutamoto T, Kawahara C, Nishiyama K, Yamamoto T, Fujii M, Horie M. Serum Cortisol as a Useful Predictor of Cardiac Events in Patients With Chronic Heart Failure. Circ Heart Fail 2009; 2:608-15. [DOI: 10.1161/circheartfailure.109.868513] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Masayuki Yamaji
- From the Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan
| | - Takayoshi Tsutamoto
- From the Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan
| | - Chiho Kawahara
- From the Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan
| | - Keizo Nishiyama
- From the Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan
| | - Takashi Yamamoto
- From the Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan
| | - Masanori Fujii
- From the Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan
| | - Minoru Horie
- From the Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan
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Ma ZS, Ma SJ, Dong MF, Wang JT, Wang LX. Effect of Captopril on Pulmonary Artery Pressure Following Corrective Surgery for Tetralogy of Fallot. J Card Surg 2009; 24:553-7. [DOI: 10.1111/j.1540-8191.2009.00873.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clerico A, Vittorini S, Passino C, Emdin M. New and emerging biomarkers of heart failure. Crit Rev Clin Lab Sci 2009; 46:107-28. [DOI: 10.1080/10408360902722342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tsutamoto T, Tanaka T, Sakai H, Nishiyama K, Fujii M, Yamamoto T, Nakae I, Ohnishi M, Wada A, Horie M. Beneficial effect of perindopril on cardiac sympathetic nerve activity and brain natriuretic peptide in patients with chronic heart failure: comparison with enalapril. Circ J 2008; 72:740-6. [PMID: 18441453 DOI: 10.1253/circj.72.740] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In patients with chronic heart failure (CHF), it remains unclear whether perindopril is more cardioprotective than enalapril. METHODS AND RESULTS Forty-five stable CHF outpatients undergoing conventional therapy including enalapril therapy were randomized to 2 groups [group I (n=24): continuous enalapril treatment; group II (n=21): enalapril was changed to perindopril]. Cardiac sympathetic nerve activity was evaluated using cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy, hemodynamic parameters and neurohumoral factors before and 6 months after treatment. There was no difference in baseline characteristics between the 2 groups. In group I, there were no changes in MIBG parameters, left ventricular ejection fraction (LVEF) or plasma level of brain natriuretic peptide (BNP). In contrast, in group II the delayed heart/mediastinum count ratio was significantly increased (2.0+/-0.07 vs 2.15+/-0.07, p=0.013) and the washout rate was significantly decreased (33.0+/-1.4 vs 30.5+/-1.2, p=0.030) after 6 months compared with the baseline value. In addition, LVEF was significantly increased and the plasma BNP level was significantly decreased. CONCLUSION These findings suggest that for the treatment of CHF, perindopril is superior to enalapril with respect of cardiac sympathetic nerve activity and BNP.
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Affiliation(s)
- Takayoshi Tsutamoto
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan.
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