Essential Hypertension: Renin and Aldosterone, Heart Attack and Stroke

In 219 patients with essential hypertension, aldosterone excretion and plasma renin activity were related to daily sodium excretion and compared to a nomogram drawn from 52 normal volunteers studied over the same continuous range of sodium balance. Plasma renin activity was subnormal in 27 per cent, normal in 57 per cent and elevated in 16 per cent. Further study showed eight patterns of renin and aldosterone secretion. Patients with normal or high renin had an 11 and 14 per cent frequency respectively of heart attacks or strokes. However, during a similar period of observation, none of 59 low renin patients had any of these complications. They appear protected despite similar hypertension, similar left ventricular enlargement, and despite higher mean age. Plasma renin activity emerges as a potential risk factor for patients with essential hypertension — useful for identifying etiologies, determining prognosis and applying therapy.