Elevated plasma renin activity predicts adverse outcome in chronic heart failure, independently of pharmacologic therapy

Data from the Valsartan heart failure trial (Val-HeFT)

Serge Masson, Scott Solomon, Laura Angelici, Roberto Latini, Inder S. Anand, Margaret Prescott, Aldo P. Maggioni, Gianni Tognoni, Jay N. Cohn

Research output: Contribution to journalArticle

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Abstract

Background: The prognostic value of plasma renin activity (PRA) in chronic heart failure (HF) has been assessed before the widespread use of angiotensin-converting enzyme inhibitors (ACEi) and beta-blockers, which exert opposite effects on renin secretion. We evaluated the association between PRA and outcome in patients with chronic HF treated with ACEi and beta-blockers. Methods and Results: PRA was measured in 4,291 patients from the Valsartan Heart Failure Trial (Val-HeFT). The prognostic performance of PRA in patients who were or were not taking ACEi or beta-blockers was evaluated by multivariable Cox models. PRA was elevated in patients on ACEi (median 5.85 [interquartile range (IQR) 1.82-17.83] ng/mL/h) compared with those not on ACEi (1.57 [0.74-4.15] ng/mL/h), and lower in those on beta-blockers (3.89 [1.17-12.61] ng/mL/h) than in those not on beta-blockers (6.21 [1.97-19.24] ng/mL/h). Lower systolic blood pressure, higher plasma aldosterone, and ACEi were associated with high PRA. Higher PRA was a strong and independent predictor of mortality in the whole population and in patients who were or were not treated with ACEi or beta-blockers. Conclusions: PRA is a powerful prognostic marker of death over a wide range of concentrations in patients with chronic HF. Prescription of ACEi and/or beta-blockers does not influence the relation between PRA and outcome.

Original languageEnglish (US)
Pages (from-to)964-970
Number of pages7
JournalJournal of cardiac failure
Volume16
Issue number12
DOIs
StatePublished - Dec 1 2010

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Valsartan
Renin
Angiotensin-Converting Enzyme Inhibitors
Heart Failure
Therapeutics
Blood Pressure

Keywords

  • Heart failure
  • Renin

Cite this

Elevated plasma renin activity predicts adverse outcome in chronic heart failure, independently of pharmacologic therapy : Data from the Valsartan heart failure trial (Val-HeFT). / Masson, Serge; Solomon, Scott; Angelici, Laura; Latini, Roberto; Anand, Inder S.; Prescott, Margaret; Maggioni, Aldo P.; Tognoni, Gianni; Cohn, Jay N.

In: Journal of cardiac failure, Vol. 16, No. 12, 01.12.2010, p. 964-970.

Research output: Contribution to journalArticle

Masson, Serge ; Solomon, Scott ; Angelici, Laura ; Latini, Roberto ; Anand, Inder S. ; Prescott, Margaret ; Maggioni, Aldo P. ; Tognoni, Gianni ; Cohn, Jay N. / Elevated plasma renin activity predicts adverse outcome in chronic heart failure, independently of pharmacologic therapy : Data from the Valsartan heart failure trial (Val-HeFT). In: Journal of cardiac failure. 2010 ; Vol. 16, No. 12. pp. 964-970.
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abstract = "Background: The prognostic value of plasma renin activity (PRA) in chronic heart failure (HF) has been assessed before the widespread use of angiotensin-converting enzyme inhibitors (ACEi) and beta-blockers, which exert opposite effects on renin secretion. We evaluated the association between PRA and outcome in patients with chronic HF treated with ACEi and beta-blockers. Methods and Results: PRA was measured in 4,291 patients from the Valsartan Heart Failure Trial (Val-HeFT). The prognostic performance of PRA in patients who were or were not taking ACEi or beta-blockers was evaluated by multivariable Cox models. PRA was elevated in patients on ACEi (median 5.85 [interquartile range (IQR) 1.82-17.83] ng/mL/h) compared with those not on ACEi (1.57 [0.74-4.15] ng/mL/h), and lower in those on beta-blockers (3.89 [1.17-12.61] ng/mL/h) than in those not on beta-blockers (6.21 [1.97-19.24] ng/mL/h). Lower systolic blood pressure, higher plasma aldosterone, and ACEi were associated with high PRA. Higher PRA was a strong and independent predictor of mortality in the whole population and in patients who were or were not treated with ACEi or beta-blockers. Conclusions: PRA is a powerful prognostic marker of death over a wide range of concentrations in patients with chronic HF. Prescription of ACEi and/or beta-blockers does not influence the relation between PRA and outcome.",
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T1 - Elevated plasma renin activity predicts adverse outcome in chronic heart failure, independently of pharmacologic therapy

T2 - Data from the Valsartan heart failure trial (Val-HeFT)

AU - Masson, Serge

AU - Solomon, Scott

AU - Angelici, Laura

AU - Latini, Roberto

AU - Anand, Inder S.

AU - Prescott, Margaret

AU - Maggioni, Aldo P.

AU - Tognoni, Gianni

AU - Cohn, Jay N.

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Background: The prognostic value of plasma renin activity (PRA) in chronic heart failure (HF) has been assessed before the widespread use of angiotensin-converting enzyme inhibitors (ACEi) and beta-blockers, which exert opposite effects on renin secretion. We evaluated the association between PRA and outcome in patients with chronic HF treated with ACEi and beta-blockers. Methods and Results: PRA was measured in 4,291 patients from the Valsartan Heart Failure Trial (Val-HeFT). The prognostic performance of PRA in patients who were or were not taking ACEi or beta-blockers was evaluated by multivariable Cox models. PRA was elevated in patients on ACEi (median 5.85 [interquartile range (IQR) 1.82-17.83] ng/mL/h) compared with those not on ACEi (1.57 [0.74-4.15] ng/mL/h), and lower in those on beta-blockers (3.89 [1.17-12.61] ng/mL/h) than in those not on beta-blockers (6.21 [1.97-19.24] ng/mL/h). Lower systolic blood pressure, higher plasma aldosterone, and ACEi were associated with high PRA. Higher PRA was a strong and independent predictor of mortality in the whole population and in patients who were or were not treated with ACEi or beta-blockers. Conclusions: PRA is a powerful prognostic marker of death over a wide range of concentrations in patients with chronic HF. Prescription of ACEi and/or beta-blockers does not influence the relation between PRA and outcome.

AB - Background: The prognostic value of plasma renin activity (PRA) in chronic heart failure (HF) has been assessed before the widespread use of angiotensin-converting enzyme inhibitors (ACEi) and beta-blockers, which exert opposite effects on renin secretion. We evaluated the association between PRA and outcome in patients with chronic HF treated with ACEi and beta-blockers. Methods and Results: PRA was measured in 4,291 patients from the Valsartan Heart Failure Trial (Val-HeFT). The prognostic performance of PRA in patients who were or were not taking ACEi or beta-blockers was evaluated by multivariable Cox models. PRA was elevated in patients on ACEi (median 5.85 [interquartile range (IQR) 1.82-17.83] ng/mL/h) compared with those not on ACEi (1.57 [0.74-4.15] ng/mL/h), and lower in those on beta-blockers (3.89 [1.17-12.61] ng/mL/h) than in those not on beta-blockers (6.21 [1.97-19.24] ng/mL/h). Lower systolic blood pressure, higher plasma aldosterone, and ACEi were associated with high PRA. Higher PRA was a strong and independent predictor of mortality in the whole population and in patients who were or were not treated with ACEi or beta-blockers. Conclusions: PRA is a powerful prognostic marker of death over a wide range of concentrations in patients with chronic HF. Prescription of ACEi and/or beta-blockers does not influence the relation between PRA and outcome.

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