Plasma renin activity is a strong and independent prognostic indicator in patients with acute decompensated heart failure treated with renin-angiotensin system inhibitors

Circulation Journal : Official Journal of the Japanese Circulation Society
Tomoya UedaYoshihiko Saito

Abstract

The renin-angiotensin system (RAS) is activated in heart failure (HF) as a compensatory mechanism, being related to cardiac remodeling and poor prognosis. Although RAS inhibitors are used as first-line drugs for HF, plasma renin activity (PRA) is upregulated by RAS inhibitors via a negative feedback mechanism. The clinical significance of PRA during RAS inhibitor therapy is poorly understood in acute decompensated HF (ADHF). Therefore we examined the impact of PRA in HF patients already receiving RAS inhibitors. Of 611 consecutive patients with ADHF and emergency admission to hospital, we studied the impact of PRA on the prognosis of ADHF in 293 patients already receiving RAS inhibitors before admission. The patients were divided into 2 groups according to median PRA (≥ vs. <3.4 ng·ml(-1)·h(-1)). During a mean follow-up of 29.0 months, there were 124 deaths from all causes. Kaplan-Meier analysis showed that all-cause and cardiovascular mortality were significantly higher in patients with high PRA than low PRA (log-rank P=0.0002 and P<0.0001, respectively). Log PRA was an independent predictor of all-cause and cardiovascular death (HR, 1.194; 95% CI: 1.378-2.678, P<0.0001; and HR, 2.559; 95% CI: 1.610-4.144, P<0.0001, respective...Continue Reading

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Citations

Aug 1, 2015·Circulation Journal : Official Journal of the Japanese Circulation Society·Tomoya UedaYoshihiko Saito
Mar 27, 2015·Circulation Journal : Official Journal of the Japanese Circulation Society·Yukihito Sato
Mar 31, 2016·Circulation Journal : Official Journal of the Japanese Circulation Society·Tetsuro YokokawaToshihisa Anzai
May 20, 2016·Circulation Journal : Official Journal of the Japanese Circulation Society·Yuki KannoYasuchika Takeishi
Mar 8, 2018·Heart Failure Reviews·Michele CorrealeUNKNOWN Master Program Students on Drug Development for Heart Failure
Apr 26, 2019·Circulation Journal : Official Journal of the Japanese Circulation Society·Takahisa KondoToyoaki Murohara
Jan 10, 2016·American Journal of Physiology. Heart and Circulatory Physiology·Yasuki NakadaYoshihiko Saito
Apr 23, 2019·Circulation Journal : Official Journal of the Japanese Circulation Society·Daisuke KamonYoshihiko Saito
Nov 4, 2020·Journal of Korean Medical Science·Bo Eun ParkShung Chull Chae
Jul 22, 2021·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Masato NaritaHirofumi Tomita

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