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O. Bryan Holland, MD; Celso Gomez-Sanchez, MD; Carol Fairchild, RN, MS; Norman M. Kaplan, MD

Arch Intern Med. 1979;139(12):1365-1370.

Abstract
Previous studies in white and mixed-race hypertensive patient populations have generally found patients with low renin activity more responsive to diuretic therapy than patients with normal renin activity. Twenty-nine black patients (26 women and three men) with placebo diastolic blood pressure of 90 to 115 mm Hg were treated with spironolactone (100 to 400 mg/day) and hydrochlorothiazide (100/mg/day). Renin status was categorized by (1) the intravenous furosemide test, (2) ambulation during placebo, and (3) ambulation during spironolactone and hydrochlorothiazide treatment. Only seven patients were categorized identically with all methods. No method identified a low renin subgroup that was more responsive to either spironolactone or hydrochlorothiazide. Diastolic blood pressure fall with hydrochlorothiazide (18 mm Hg) and 400 mg/day of spironolactone (15 mm Hg) was similar. Thus, since black women with both low and normal renin activity are quite responsive to diuretics, renin classification to guide initial antihypertensive selection is not warranted.

(Arch Intern Med 139:1365-1370, 1979)

Author Affiliations
From the Department of Internal Medicine, University of Texas Health Science Center, Dallas.

Footnotes
Accepted for publication March 22, 1979.

Reprint requests to Department of Internal Medicine, 5323 Harry Hines Blvd, Dallas, TX 75235 (Dr Holland).

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