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A Beta‐Blocker‐Based Antihypertensive Drug Program Guided by Age and Renin
Author(s) -
Bühler F. R.,
Lütold B. E.
Publication year - 1976
Publication title -
australian and new zealand journal of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0004-8291
DOI - 10.1111/j.1445-5994.1976.tb03332.x
Subject(s) - medicine , renin–angiotensin system , antihypertensive drug , blood pressure , plasma renin activity , beta blocker , essential hypertension , cardiology , endocrinology , heart failure
Summary: A beta‐blocker‐based antihypertensive drug program guided by age and renin. From analyses of the effectiveness of beta‐blocker monotherapy in relation to the patient's age and to pre‐treatment renin determinations an antihypertensive drug program is proposed in which beta‐blockers form the cornerstone. Patients with essential hypertension can be subdivided into groups with low (19%), normal (59%), or high (23%) renin sodium index. The proportion with low renin hypertension increases with age. Patients with high renin fall into two categories: younger patients with fairly mild hypertension and older patients with more severe hypertension and signs of renal disease. The antihypertensive efficacy of beta‐blocker monotherapy is best in high renin forms, good but less consistent in normal renin patients and uniformly bad in low renin hypertensives. In relation to age, beta‐blockers normalized blood pressure (≤ 95 mmHg diastolic) in three‐quarters of the younger than 40‐year‐olds, in about half of those aged 40–60 years, but in only 20% of those aged over 60 years. On this basis, it is postulated that the older patients with a low renin exhibit a relatively hypoadrenergic state while those with a normal or high renin—for a given age and elevated pressure—have a relatively increased adrenergic nervous activity. Because the beta‐blockers have a potent suppressive action on the renin‐angiotensin system—and, as a consequence, on angiotensin vasoconstriction, aldosterone volume expansion and central stimulatory feedback mechanisms—their antihypertensive mode of action may be linked to an important extent, though not exclusively, to renin suppression.