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  • Title: Effect of antihypertensive drugs on the renin-angiotensin system.
    Author: Johnston CI.
    Journal: Drugs; 1976; 12(4):274-91. PubMed ID: 786609.
    Abstract:
    Renin release from the kidneys is controlled by four major mechanisms - renal baroreceptors, the macula densa, the sympathetic nervous system and other humoral and ionic influences. Recently, the importance of the sympathetic nervous system in modulating renin release for a variety of stimuli has become apparent. The sympathetic adrenergic nerves act on a specific beta-receptor to stimulate renin release from the kidney. Those antihypertensive drugs that inhibit adrenergic nerve transmission tend therefore to lower plasma renin. beta-Adrenoreceptor blocking drugs also generally lower plasma renin by specific inhibition of renal renin release both in animals and humans. Diuretics and vasodilators in contrast elevate plasma renin levels. Plasma renin levels in hypertensive patients are the net result of many diverse influences, and similarly in patients treated with antihypertensive drugs the plasma renin level often is the result of opposing influences. Plasma renin levels tend to return towards normal levels after treatment in hypertensive patients. Plasma renin levels may offer a guide to a more rational basis for antihypertensive therapy in the future. However, the primary aim in treatment of the hypertensive patient should be to lower his blood pressure, independent of the effect of plasma renin levels. The interrelationship between the renin-angiotensin syste and the sympathetic nervous system is reviewed and the effect of antihypertensive drugs on renin release and plasma renin levels discussed. Some of the evidence in support of the importance of the sympathetic nervous system in the control of renin secretion is presented. A great variety of catecholamines have been shown to increase renin release both in vitro and in vivo. Renal renin release may be mediated by intrarenal alpha- and beta-adrenoreceptors. There are also a variety of humoral agents which act to stimulate renin release. A list of pharmacological agents which have been reported to increase or decrease renin release or plasma renin levels is presented. These drugs include diuretics, vasodilators, drugs acting on the sympathetic nervous sytem, central acting agents, beta-adrenoreceptor blocking drugs, oral contraceptives, steroids, levodopa and lithium. In patients treated with antihypertensive drugs the plasma renin leve often is the result of opposing influences. Plasma renin levels tend to return towards normal levels after treatment in hypertensive patients, and may offer a guide to a more rational basis for antihypertensive therapy by tailoring specific therapeutic agents to the patient's biochemical profile as revealed by plasma renin measurements.
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