From the Guidelines
Elevated renin levels should be addressed by targeting the renin-angiotensin-aldosterone system (RAAS) for effective blood pressure control, with a goal of achieving blood pressure levels below 130/80 mmHg, as recommended by the European Society of Hypertension and the European Society of Cardiology 1. To achieve this goal, combination therapy of several antihypertensive agents, including loop diuretics, is usually required.
- Angiotensin receptor blockers, ACE inhibitors, or a combination of both are recommended to reduce proteinuria and achieve blood pressure control.
- The use of these agents is supported by evidence from several controlled randomized trials, which have shown their effectiveness in preventing and reducing microalbuminuria and proteinuria in patients with type 2 diabetes 1.
- In addition to pharmacological treatment, lifestyle modifications such as strict blood pressure control, lowering proteinuria, and intensive lifestyle measures, including caloric restriction and increased physical activity, should be implemented to favor weight reduction and improve glucose tolerance.
- Regular monitoring of blood pressure, kidney function, and electrolytes is essential when using these medications, with assessments recommended at 2-4 weeks after initiation and dose adjustments.
- The choice of medication should be individualized based on the patient's specific needs and medical history, with consideration given to the potential benefits and risks of each agent.
- For example, ACE inhibitors like lisinopril or ARBs such as losartan may be suitable for patients with high renin hypertension, while diuretics like hydrochlorothiazide can be added to enhance the effectiveness of RAAS blockers.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Renin Elevation and BP Control
- Renin-angiotensin-aldosterone system antagonists, such as angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs), are recommended as first-line drugs for hypertension treatment 2.
- ACE inhibitors and ARBs have been shown to have a comparable effect in lowering blood pressure levels, but ARBs are characterized by better pharmacological tolerability 3.
- The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk, with first-line drug therapy consisting of a thiazide or thiazidelike diuretic, an ACE inhibitor or ARB, and a calcium channel blocker 4.
- Lifestyle modifications, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption, are also essential for BP control and can enhance the efficacy of pharmacologic therapy 4, 5.
Resistant Hypertension
- Resistant hypertension is a condition where blood pressure levels remain elevated above target despite changes in lifestyle and concurrent use of at least three antihypertensive agents, including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system, and a diuretic 6.
- The key management points of resistant hypertension include lifestyle changes, rationalization of current treatment, and consideration of alternative treatments such as mineralocorticoid receptor antagonists 6.
BP Lowering and CVD Risk
- Randomized clinical trials have established the efficacy of BP lowering to reduce the risk of CVD morbidity and mortality, with an SBP reduction of 10 mm Hg decreasing the risk of CVD events by approximately 20% to 30% 4.
- Optimal control of high blood pressure levels is recommended to reduce the global burden of hypertensive-mediated organ damage and cardiovascular events 2.