Plasma Renin Activity Is a Strong and Independent Prognostic Indicator in Patients With Acute Decompensated Heart Failure Treated With Renin-Angiotensin System Inhibitors

• Ueda Tomoya

  First Department of Internal Medicine, Nara Medical University

• Kawakami Rika

  First Department of Internal Medicine, Nara Medical University

• Nishida Taku

  First Department of Internal Medicine, Nara Medical University

• Onoue Kenji

  First Department of Internal Medicine, Nara Medical University

• Soeda Tsunenari

  First Department of Internal Medicine, Nara Medical University

• Okayama Satoshi

  First Department of Internal Medicine, Nara Medical University

• Takeda Yukiji

  First Department of Internal Medicine, Nara Medical University

• Watanabe Makoto

  First Department of Internal Medicine, Nara Medical University

• Kawata Hiroyuki

  First Department of Internal Medicine, Nara Medical University

• Uemura Shiro

  First Department of Internal Medicine, Nara Medical University

• Saito Yoshihiko

  First Department of Internal Medicine, Nara Medical University Department of Regulatory Medicine for Blood Pressure, Nara Medical University

抄録

Background: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.Methods and Results: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, respectively).Conclusions:PRA was associated with an increased risk of all-cause and cardiovascular mortality in ADHF patients already receiving RAS inhibitors, suggesting that PRA would be a useful biomarker during ADHF treatment. (Circ J 2015; 79: 1307–1314)

収録刊行物

• Circulation Journal

  Circulation Journal 79 (6), 1307-1314, 2015

  一般社団法人 日本循環器学会

キーワード

• Acute decompensated heart failure
• Plasma renin activity
• Prognosis
• Renin-angiotensin system blocker

詳細情報

• CRID: 1390001205106257024
• NII論文ID: 130005073144
• NII書誌ID: AA11591968
• DOI: 10.1253/circj.cj-14-1203
• ISSN: 13474820
• ISSN: 13469843
• NDL書誌ID: 026398846
• PubMed: 25753468
• Web Site: https://ndlsearch.ndl.go.jp/books/R000000004-I026398846
• Web Site: https://www.jstage.jst.go.jp/article/circj/79/6/79_CJ-14-1203/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2015333543
• 本文言語コード: en
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