Table 2.
Impact of MRA Treatment on Plasma Renin and Aldosterone Concentrations Relative to Other Antihypertensive Agents
| A | AHT changes (n = 107) | No AHT changes (n = 39) | P value | |||
|---|---|---|---|---|---|---|
| Baseline | After MRA | Baseline | After MRA | a | b | |
| PAC | 19.8 [13.9, 27.9] | 27.2 [17.9, 45.5] | 16.5 [10.2, 26.8] | 21.2 [14.2, 39.0] | .0003 | .11 |
| PRA | 0.5 [0.1, 0.8] | 1.2 [0.6, 5.0] | 0.6 [0.1, 0.8] | 1.2 [0.6, 2.3] | .003 | .20 |
| ARR | 41.0 [19.5, 103.7] | 27.2 [7.4, 61.3] | 34.8 [16.1, 98.2] | 17.9 [8.7, 38.3] | .0009 | .27 |
| B | Beta-blocker use (n = 26) | No beta-blocker use (n = 13) | P value | |||
| Baseline | After MRA | Baseline | After MRA | a | b | |
| PAC | 22.2 [13.0, 29.0] | 23.9 [20.2, 40.1] | 15.2 [7.7, 18.7] | 14.4 [10.3, 27.4] | .004 | .34 |
| PRA | 0.6 [0.1, 1.0] | 0.9 [0.6, 2.1] | 0.5 [0.2, 0.7] | 1.2 [0.6, 3.0] | .003 | .54 |
| ARR | 45.7 [16.6, 125.0] | 24.0 [8.6, 70.5] | 31.2 [10.4, 52.4] | 15.8 [10.4, 20.1] | .03 | .11 |
| C | ACEI and ARB use (n = 20) | No ACEI and ARB use (n = 19) | P value | |||
| Baseline | After MRA | Baseline | After MRA | a | b | |
| PAC | 18.2 [9.7, 29.2] | 23.3 [12.7, 41.6] | 16.5 [10.4, 23.8] | 20.3 [15.1, 32.6] | .003 | .88 |
| PRA | 0.6 [0.2, 1.7] | 1.3 [0.6, 2.7] | 0.2 [0.1, 0.7] | 0.9 [0.3, 2.2] | .003 | .31 |
| ARR | 21.7 [10.8, 83.1] | 14.3 [2.4, 33.4] | 50.5 [27.1, 102.4] | 24.0 [14.5, 51.5] | .02 | .99 |
Abbreviations: ACEI = angiotensin-converting enzyme inhibitor; AHT = antihypertensive agent; ARB = angiotensin receptor blocker; ARR = aldosterone/renin ratio; MRA = mineralocorticoid receptor antagonist; PAC = plasma aldosterone concentration; PRA = plasma renin activity.
PAC (ng/dL), PRA (ng/mL/h), and ARR (ng/dL per ng/mL/h) are shown as median [interquartile range]. The number of cases with available PRA in patients with vs. no additional medication changes were: 84 and 30 in the panel A; 19 and 11 in the panel B; 15 and 15 in the panel C, respectively. Direct renin concentration (DRC) is not shown due to small number of patients per subgroup. In cases with DRC measurements, ARRs are calculated using a conversion factor of DRC/PRA of 8. Two-way repeated measures analyses of variance were used to assess the effect of MRA use (a) and subgroup (b) on PAC, PRA, and ARR. The interactions between MRA use and subgroup were not significant in all cases.