High blood pressure, or hypertension, affects nearly half of all Americans, yet many are unaware they have it. The condition occurs when blood flows through the arteries at pressures higher than normal.
Blood pressure is measured with two numbers: systolic, the pressure when the heart pumps blood out, and diastolic, the pressure between heartbeats when the heart refills with blood.
While many people rely on medication to manage hypertension, a study from Yeshiva University reveals a surprising finding: some commonly prescribed blood pressure medications can actually raise blood pressure in certain patients.
This reaction, called a “pressor response,” underscores the importance of tailoring treatments based on individual factors, particularly a patient’s renin levels.
Renin is an enzyme produced by the kidneys that plays a critical role in regulating blood pressure.
The study suggests that a simple blood test to measure renin levels could help doctors select the most effective medication for each patient, potentially avoiding dangerous mismatches between drugs and patient biology.
Although this test is not yet standard practice, it is becoming more widely available and could significantly improve hypertension management.
The researchers analyzed data from 945 patients who participated in a workplace treatment program in New York City between 1981 and 1998.
These individuals, none of whom had been treated for high blood pressure before, all had systolic blood pressure (SBP) readings of at least 140 mmHg. SBP is the top number in a blood pressure reading and represents the force of blood against artery walls when the heart contracts.
Each patient was prescribed one of two types of blood pressure medications: “V drugs,” like diuretics and calcium channel blockers, which lower blood volume, or “R drugs,” such as beta blockers and ACE inhibitors, which reduce renin levels.
Researchers measured renin activity and SBP at the start of the study and then monitored blood pressure changes after one to three months of treatment.
The results were striking. Patients with low renin levels who were prescribed R drugs, like beta blockers or ACE inhibitors, were the most likely to experience a pressor response—a significant rise in SBP of 10 mmHg or more.
Overall, 7.7% of the patients experienced this adverse reaction, but the rate was highest—16%—in those with low renin levels on R drugs. This indicates that the mismatch between renin levels and medication type can cause treatment to backfire.
Doctors often attribute poor responses to medication to random factors or patient non-compliance, but this study highlights a different explanation: an incompatibility between the patient’s renin profile and the chosen drug.
The researchers argue that renin testing could prevent this problem, helping to identify the right medication for each individual.
Two groups of patients could especially benefit from renin testing: those starting blood pressure treatment for the first time and those taking multiple medications that may not be necessary.
By pinpointing the most effective treatment from the beginning, doctors could avoid over-prescribing and reduce the risk of complications.
This study, led by Michael Alderman and published in the American Journal of Hypertension, provides compelling evidence for a more personalized approach to treating high blood pressure.
As renin testing becomes more accessible, it could transform hypertension care, ensuring that patients receive the safest and most effective treatments for their condition.
If you care about high blood pressure, please read studies that drinking tea could help lower blood pressure, and early time-restricted eating could help improve blood pressure.
For more health information, please see recent studies about added sugar in your diet linked to higher blood pressure, and results showing vitamin D could improve blood pressure in people with diabetes.
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