[Plasma Renin Activity and Potential of Indapamide Retard to Improve Control of Hypertension].

PURPOSE: to study plasma renin activity (PRA) as a predictor of antihypertensive response to addition of diuretic to combination of angiotensin-converting enzyme inhibitor (ACEI) and calcium antagonist (CA). MATERIAL AND METHODS: The study included 72 patients (39% men, mean age 62.0+/-8.3 years) with uncontrolled despite use of ACEI and CA arterial hypertension (AH) without overt associated clinical conditions (AH criteria of national guidelines, 2010). After 4 weeks of therapy with ACE inhibitor (quadropril 6 mg/day) and CA (felodipine 5 mg/day) in all patients who did not reach target level of blood pressure (BP) (clinical BP more or equal 140/90 mm Hg, daytime BP according to ambulatory BP monitoring [ABPM] >135/85 mm Hg) indapamide retard (1.5 mg/day) was added to combination therapy for 6 months. Examination included measurement of baseline and on treatment PRA and repetitive ABPM. RESULTS: More pronounced antihypertensive response was observed in the group of patients with volume dependent AH. Baseline BP was 156.6+/-14.1/86.7+/-1.5 and 151.9+/-17.1/78.0+/-7.8 mm Hg, on treatment level of clinical BP - 126.2+/-10.6/72.5+/-11.6 and 132.2+/-9.1/71.9+/-7.2 mm Hg (p<0.05) in patients with volume dependent and renin dependent AH, respectively. Target clinical BP was achieved in 95 and 80% of patients, respectively (2=10.3; p<0.05). According to ABPM both daytime and nighttime on treatment BP was lower in the group of patients with volume dependent AH (130.0+/-11.0/74.1+/-9.9 vs. 136.5+/-7.3/78.8+/-8.2 mm Hg, p<0.05; and 127.9+/-15.8/71+/-13.5 vs. 132.6+/-13.0/74.5+/-10.2 mm Hg, p<0.05). CONCLUSION: PRA is an independent predictor of antihypertensive response to addition of a diuretic to combination therapy with ACEI and CA.