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Renin-Aldosterone Profiling in Hypertension
- JERRY R. MITCHELL, M.D., Ph.D.;
- ADDISON A. TAYLOR, M.D., Ph.D.;
- JAMES L. POOL, M.D.;
- C. RAYMOND LAKE, M.D., Ph.D.;
- DOUGLAS E. ROLLINS, M.D., Ph.D.; and
- FREDERIC C. BARTTER, M.D.
Abstract
Renin-aldosterone profiling was used to classify patients with hypertension: 243 patients with essential hypertension were classified by renin-urinary sodium indexing; 107 were reclassified by response to administration of furosemide and intravenous saline; 45 were further classified by response to a low-sodium diet. Arbitrary "normal ranges" were determined in 89, 32, and 38 volunteers, respectively. Patients with low-renin apparently do not have "high-volume" hypertension. Rather, they show a primary renal abnormality in renin secretion and become relatively deficient in angiotensin II and aldosterone when they are subjected to diuresis. They can maintain aldosterone secretion under normal conditions because their adrenal aldosterone receptor is supersensitive to angiotensin II. No evidence of abnormal sympathetic neural activity was found among the renin subgroups. Renin-aldosterone profiling in current clinical practice seems useful mainly in the detection of patients with curable forms of secondary hypertension. Aldosterone/renin ratios may be particularly helpful in diagnosis when obtained after a patient has undergone expansion or contraction of his extracellular fluid volume.
Article and Author Information
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▸An edited transcription of a Combined Clinical Staff Conference at the Clinical Center, Bethesda, Maryland, 21 October 1976, by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health, Education, and Welfare.
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▸Authors who wish to cite a section of this conference and specifically indicate its author can use this example for the form of reference:
TAYLOR AA: Use of renin and aldosterone measurements to define pathophysiology, pp. 599-603 in MITCHELL JR (moderator): Renin-aldosterone profiling in hypertension. Ann Intern Med 87:596-612, 1977
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▸Requests for reprints should be addressed to Jerry R. Mitchell, M.D., Section on Hypertension and Clinical Pharmacology, Department of Medicine, Baylor College of Medicine; 6516 Bertner; Houston, TX 77030.
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- Received July 14, 1977.
- Accepted August 22, 1977.
