AIM: Plasma renin activity (PRA) is regarded as a marker of sodium and fluid homeostasis in patients with primary hypertension. Whether effects of diuretics on PRA differ according to class of diuretic, whether diuretics lead to a sustained increase in PRA, and whether changes in PRA relate to those in blood pressure (BP) is unknown. We performed a systematic review and meta-analysis of trials investigating the antihypertensive effects of diuretic therapy in which PRA and/or other biomarkers of fluid homeostasis were measured before and after treatment.

METHODS: Three databases were searched: MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials (CENTRAL). Titles were firstly screened by title and abstract for relevancy before full-text articles were assessed for eligibility according to a pre-defined inclusion/exclusion criteria.

RESULTS: A total of 1684 articles were retrieved of which 61 met the pre-specified inclusion/exclusion criteria. PRA was measured in 30/61 studies. Diuretics lead to a sustained increase in PRA which was similar for different classes of diuretic (standardised mean difference [95% CI] 0.481 [0.362, 0.601], 0.729 [0.181, 1.28], 0.541 [0.253, 0.830] and 0.548 [0.159, 0.937] for thiazide, loop, mineralocorticoid receptor antagonists/potassium-sparing and combination diuretics respectively, Q = 0.897, P = 0.826), nor to the decrease in BP.

CONCLUSION: In anti-hypertensive drug trials, diuretics lead to a sustained increase in average PRA which is similar across different classes of diuretic and is unrelated to the average reduction in BP.

Original languageEnglish
JournalBritish Journal of Clinical Pharmacology
Publication statusE-pub ahead of print - 21 Oct 2020


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