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Meta-Analysis
. 2021 May;87(5):2189-2198.
doi: 10.1111/bcp.14597. Epub 2021 Apr 9.

Effect of diuretics on plasma renin activity in primary hypertension: A systematic review and meta-analysis

Ryan J McNally  1 , Luca Faconti  1 , Marina Cecelja  1 , Bushra Farukh  1 , Christopher N Floyd  1 , Philip J Chowienczyk  1
Affiliations
Free article
Meta-Analysis

Effect of diuretics on plasma renin activity in primary hypertension: A systematic review and meta-analysis

Ryan J McNally et al. Br J Clin Pharmacol. 2021 May.
Free article

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.

Keywords: blood pressure; hypertension; plasma renin activity; renin.

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References

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