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Susan M. Hailpern, Jean E. Sealey, John H. Laragh, Michael H. Alderman, OR-3: Plasma renin activity predicts myocardial infarction/revascularization among hypertensive patients, American Journal of Hypertension, Volume 18, Issue S4, May 2005, Page 1A, https://doi.org/10.1016/j.amjhyper.2005.03.003
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Abstract
To determine whether plasma renin activity (PRA) predicts myocardial infarction (MI) and revascularization (Revas) events, we examined the pre-treatment PRA levels of 3,763 subjects with mild-to-moderate hypertension in the Worksite Hypertension Control Program (mean age 52.3 ± 9.5 years; 33.7% White; 30.1% Black; 63% male). Baseline and treatment blood pressure were 150.0 ± 19.1/95.7 ± 18.1 and 136.2 ± 15.8/ 83.9 ± 9.4, respectively. PRA was classified by three strata: high (H) ≥4.5 ng/mL/h (n=406), normal (N) 4.49–0.65 ng/mL/h (n=2,261), and low (L) <0.65 ng/mL/h (n=1,096). MI/Revas outcomes were defined as those with ICD9 codes 410–414.9. Creatinine clearance (CrCl) was estimated by the Cockcroft-Gault equation and was dichotomized as ≤60 ml/min and normal. Cox proportional hazards models were constructed for MI/Revas and the following cardiovascular risk factors: PRA, age, sex, ethnicity, pre-treatment systolic blood pressure, cholesterol, diabetes, body mass index, CrCl, smoking, a previous history of MI or stroke, and left ventricular hypertrophy. During a mean follow-up of 5.98 years (range 0.49–18.00) 100 MI/Revas events occurred. Subjects with H-PRA had higher age-sex adjusted MI/Revas rates than those with L-PRA (8.4/1000 person-years vs. 3.29; p=0.001). After adjusting for cardiovascular risk factors, PRA as a continuous variable had a significant positive association with MI/Revas (HR= 1.23; CI: 1.053, 1.440; p=0.009). PRA had a significant positive association with MI/Revas among males (HR= 1.32; CI: 1.126, 1.560) and Whites (HR=1.258; CI:1.003, 1.576; p=0.047), but not among females or Blacks. No association was observed between PRA and stroke. Among successfully controlled hypertensive subjects, pretreatment PRA was independently associated with risk of MI/Revas.
- myocardial infarction
- smoking
- hypertension
- body mass index procedure
- diabetes mellitus
- heart disease risk factors
- systolic blood pressure
- cerebrovascular accident
- ischemic stroke
- left ventricular hypertrophy
- diabetes mellitus, type 2
- blood pressure
- cholesterol
- african continental ancestry group
- ethnic group
- follow-up
- european continental ancestry group
- workplace
- creatinine clearance
- international classification of diseases
- revascularization
- interval data
- plasma renin activity
