Plasma renin activity and its association with ischemic heart disease, congestive heart failure, and cerebrovascular disease in a large hypertensive cohort

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.

Figure 1

The study cohort was identified from Kaiser Permanente Southern California members aged 18 years and older with diagnosed hypertension and documented plasma renin activity (PRA) and aldosterone measurements. The 7887 individuals who met the inclusion criteria were further categorized by population‐based quartiles based on their PRA values.

Figure 2

Plasma renin activity (PRA) distribution among the study cohort (N=7887). The median PRA was 1.30 ng/mL/h, with values ranging from undetectable to as high as 16.5 ng/mL/h.

Figure 3

Adjusted odds ratios based on column (1) plasmin renin activity (PRA), column (2) aldosterone, and column (3) aldosterone:renin ratio (ARR). Rows describe the quartiles for (A) ischemic heart disease (IHD), (B) chronic heart failure (CHF), and (C) cerebrovascular disease (CED). The results demonstrate a relationship between higher PRA with IHD and CHF but not CED. ARR demonstrated a similar pattern of association but in an inverse manner. *P<.05.