High blood pressure, or hypertension, affects nearly half of all Americans, and many are unaware they have it. This condition occurs when blood flows through the arteries at higher-than-normal pressures, increasing the risk of heart disease and stroke.
Blood pressure readings are made up of two numbers: systolic (when the heart pumps blood) and diastolic (when the heart rests between beats).
A recent study from Yeshiva University has uncovered an important insight into hypertension treatment: some commonly prescribed drugs to lower blood pressure can actually raise it in certain patients.
This reaction, known as a “pressor response,” underscores the need for a more personalized approach to treating high blood pressure.
The research, published in the American Journal of Hypertension and led by Dr. Michael Alderman, suggests that measuring a patient’s renin levels could help doctors choose the most effective medication.
Renin is an enzyme released by the kidneys that plays a key role in regulating blood pressure.
The study analyzed 945 patients with systolic blood pressure (SBP) of at least 140 mmHg, the threshold for hypertension.
None of the participants had received treatment for high blood pressure before enrolling in the study, which took place in New York City from 1981 to 1998.
Each patient was given one of two types of antihypertensive drugs:
- “R drugs” (beta blockers or ACE inhibitors) lower renin levels.
- “V drugs” (diuretics or calcium channel blockers) lower blood volume.
Before treatment, the researchers measured each patient’s plasma renin activity (PRA) and blood pressure. After one to three months of treatment, blood pressure levels were measured again.
The results showed that renin levels could predict which patients would respond best to a particular type of drug. Additionally, the test identified patients likely to experience a pressor response—an increase in SBP of 10 mmHg or more.
Overall, 7.7% of patients experienced a pressor response. The highest percentage (16%) occurred in patients with low renin levels who were treated with R drugs. This mismatch between the drug type and the patient’s renin status likely caused the unexpected increase in blood pressure.
Doctors often attribute such reactions to patients failing to take their medication or random events. However, this study shows that these reactions are not random—they are linked to a mismatch between the medication and the patient’s renin profile.
Measuring renin levels, which can now be done through a blood test, could help doctors avoid these mismatches. The researchers suggest that two groups of patients would particularly benefit from renin testing:
- First-time patients: Those newly prescribed antihypertensive medications could receive drugs better tailored to their needs.
- Patients on multiple drugs: Those taking several blood pressure medications might achieve better results with fewer drugs if their treatment aligns with their renin levels.
This personalized approach could improve treatment outcomes and reduce unnecessary side effects. While renin testing is not yet standard practice, this study highlights its potential to transform hypertension care by matching the right drug to the right patient.
With nearly half of the U.S. population affected by high blood pressure, adopting renin testing could significantly improve how this condition is managed, helping patients achieve better control and reducing the risks associated with hypertension.
If you care about high blood pressure, please read studies that early time-restricted eating could help improve blood pressure, and coconut sugar could help reduce blood pressure and artery stiffness.
For more information about blood pressure, please see recent studies about added sugar in your diet linked to higher blood pressure, and results showing plant-based foods could benefit people with high blood pressure.
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