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Baseline renin levels and the efficacy of mineralocorticoid inhibitors: a meta-analysis
Session:
Sessão de Posters 07 - Hipertensão arterial
Speaker:
Ana Rita Leite
Congress:
CPC 2024
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.14 Risk Factors and Prevention - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Rita Ferreira Leite; António Afonso Angélico Gonçalves; Adelino Leite-Moreira; João Sérgio Neves; João Pedro Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif"><span style="color:black">Introduction</span></span></strong><span style="font-family:"Arial",sans-serif"><span style="color:black">: Hypertension (HTN) is a major contributor to cardiovascular morbidity and mortality. Heightened aldosterone production is a driving factor to HTN in several conditions. Renin levels are surrogates of mineralocorticoid receptor (MR) activity and may predict the effects of MR antagonists (MRA) and aldosterone synthase inhibitors on blood pressure (BP).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif"><span style="color:black">Aims</span></span></strong><span style="font-family:"Arial",sans-serif"><span style="color:black">: To assess whether baseline renin levels predict the BP response to mineralocorticoid inhibitors.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif"><span style="color:black">Methods</span></span></strong><span style="font-family:"Arial",sans-serif"><span style="color:black">: We collected phase II-IV randomized clinical trials (RCTs) available on PubMed and Web of Science focusing on the effect of MRAs or aldosterone synthase inhibitors on BP. The least squares mean (LSM) change of BP from baseline and 95% confidence intervals (95%CI) were extracted from the treatment effect estimates according to baseline plasma renin levels. A random-effects meta-analysis assessing baseline renin interaction on mineralocorticoid inhibitors effects on BP was performed. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Arial",sans-serif"><span style="color:black"><strong>Results</strong>: Three phase II RCTs, including 659 patients submitted to treatment with MRA (esaxerenone 1.25-5mg, eplerenone 50-100mg, spironolactone 25-50mg) or aldosterone synthase inhibitors (lorundrostat 100mg) were included. The RCTs included patients with essential HTN, uncontrolled HTN, or at risk of developing heart failure. The median follow-up period ranged from 8 to 36 weeks. Baseline plasma renin, presented as plasma renin activity (PRA) or Log2 normalized protein expression (NPX), was stratified in high and low renin groups according to the cutoff of 1 ng/mL/h for PRA or the median for NPX. MRA or aldosterone synthase inhibitors decreased systolic BP from baseline without effect modification by baseline renin levels (LSM: -15.12; 95%CI -18.62, -11.63 mmHg for the lower renin category; and LSM: -12.88; 95%CI -15.96, -9.80 mmHg for the higher renin category; p for interaction=0.34). Similarly, the decrease in diastolic BP from baseline exhibited no modification based on baseline renin levels (LSM: -7.62; 95%CI -9.67, -5.57 mmHg for the lower renin category; and LSM: -7.37; 95%CI -8.92, -5.81 mmHg for the higher renin category; p for interaction=0.85).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif"><span style="color:black">Conclusions</span></span></strong><span style="font-family:"Arial",sans-serif"><span style="color:black">: In a meta-analysis of phase II RCTs, baseline categorical renin levels did not predict the impact of mineralocorticoid inhibitors on BP. Studies with longer follow-up periods, larger populations and exploring varying renin cut-offs are needed to better understand the relation between MR activity and the efficacy of mineralocorticoid inhibitors.</span></span></span></span></p>
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