Should We Routinely Measure Renin Levels to Diagnose and Treat Patients With Hypertension? (Part I)

The Argument For

Phyllis August, MD, MPH

In This Article

Should a Trial of Renin-Guided Therapy Be Conducted?

Given the lack of adequate BP control in the population and the unequivocal importance of BP control in preventing morbidity, a clinical trial evaluating a renin-based strategy for treating hypertension could be considered. Such a trial would necessitate clear delineation of the hypothesis to be tested. Possible questions that could be answered by such a trial include: Will renin-guided therapy compared with standard of care (JNC 7 approach) lead to: 1) fewer cardiovascular events; 2) lower BP after 1 year of treatment; 3) reduced cost of treating hypertension; 4) better patient satisfaction (fewer adverse reactions); or 5) greater number of cases of curable (secondary) hypertension diagnosed? In view of the expense and duration of a trial that evaluated "hard clinical outcomes" (i.e., stroke, coronary disease), such a trial may simply be too costly; however, other outcomes such as BP control, cost, and side effects are important. Any trial that evaluates the utility of renin-based treatment of hypertension should take into consideration the cost effectiveness of this approach, since a plasma renin profile would not only add to the expense of treatment, but may also lead to additional expensive diagnostic tests. On the other hand, more effective and timelier BP control could control health care costs considerably. The logistics of conducting a clinical trial of renin-based treatment are not trivial. Should only untreated patients be studied? Should high-risk patients be studied (diabetics, elderly)? What would be appropriate inclusion/exclusion criteria?