RUOLO DEL PROFILO RENINICO E DELL'ETA' NELLA SCELTA DELL'APPROCCIO TERAPEUTICO DELL'IPERTENSIONE ARTERIOSA

A group of 116 patients with grade I-II (W.H.O.) essential hypertension was studied. A diuretic treatment was instituted as a first step of therapy in 50 patients while the remaining 66 were first treated with beta-blockers. After 6 weeks of treatment the drugs were combined in those patients who did not achieve blood pressure control; this combination therapy was again maintained for 6 weeks and, if necessary, a vasodilating agent was added thereafter. The results show that with diuretic treatment alone diastolic blood pressure was brought to normal values (<95 mmHg) in 3/4 of our low renin patients, in 2/3 of normal renin and in 1/3 of high renin hypertensives. On the contrary among the group of patients treated with a beta-blocker alone more than half of the high and normal renin patients were controlled, whereas this goal was achieved in only 1/4 of the low renin patients. Similar behaviour was observed subdividing the subjects in young (<35 yr), middle-aged (36-49 yr) and older (> 50 yr) patients. In conclusion our data indicate that age must be taken into account in classifying hypertensive patients in renin subgroups. In addition if a renin-sodium profile is available, it can be useful in choosing between diuretics or beta-blockers as a first step treatment. Alternatively, younger patients are more likely to have better hypotensive responses with beta-blocker whereas in older patients antihypertensive treatment should preferentially be started with diuretics alone.