Effect of diuretics on plasma renin activity in primary hypertension: A systematic review and meta‐analysis. Issue 5 (9th April 2021)

• Record Type: Journal Article
• Authors: McNally, Ryan J.; Faconti, Luca; Cecelja, Marina; Farukh, Bushra; Floyd, Christopher N.; Chowienczyk, Philip J.
• Is Part Of: British journal of clinical pharmacology. Volume 87:Issue 5(2021)
• Page Start: 2189
• Page End: 2198
• Publication Date: 2021-04-09
• Subjects: blood pressure -- hypertension -- plasma renin activity -- renin; Pharmacology -- Periodicals; Drugs -- Periodicals; 615.1
• DOI: 10.1111/bcp.14597
• Languages: English
• ISSNs: 0306-5251

Abstract

Abstract : Aims: Plasma renin activity (PRA) is regarded as a marker of sodium and fluid homeostasis in patients with primary hypertension. Whether effects of diuretics on PRA differ according to class of diuretic, whether diuretics lead to a sustained increase in PRA, and whether changes in PRA relate to those in blood pressure (BP) is unknown. We performed a systematic review and meta‐analysis of trials investigating the antihypertensive effects of diuretic therapy in which PRA and/or other biomarkers of fluid homeostasis were measured before and after treatment. Methods: Three databases were searched: MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials. Titles were firstly screened by title and abstract for relevancy before full‐text articles were assessed for eligibility according to a predefined inclusion/exclusion criteria. Results: A total of 1684 articles were retrieved of which 61 met the prespecified inclusion/exclusion criteria. PRA was measured in 30/61 studies. Diuretics led to a sustained increase in PRA which was similar for different classes of diuretic (standardised mean difference [95% confidence interval] 0.481 [0.362, 0.601], 0.729 [0.181, 1.28], 0.541 [0.253, 0.830] and 0.548 [0.159, 0.937] for thiazide, loop, mineralocorticoid receptor antagonists/potassium‐sparing and combination diuretics respectively, Q = 0.897, P = .826), and did not relate to the average decrease in blood pressure. Conclusion: In antihypertensive drug trials, diuretics lead to a sustained increase in average PRA, which is similar across different classes of diuretic and unrelated to the average reduction in blood pressure.