Monday, August 30, 2010

Going full circle in hypertension treatment---from renin profiling to one size fits all and back

When I was a resident in Internal Medicine in the late 70s the work of John Laragh was hot stuff. Renin profiling, although not practical in the real clinical world, was in vogue and frequently performed at the academic medical center where I trained and at other tertiary centers where it was available “in house.” It was based on the idea that pathophysiologic rationale should be used to guide treatment of hypertension. But this idea was frowned on by EBM, which gained traction in the 90s, so that renin profiling fell out of favor. Now, though, as the conversation turns increasingly toward individualized medicine, renin profiling may be making a comeback. A recent issue of the American Journal of Hypertension contains research articles and two editorials along with a podcast interview of the editorial writers calling for the adoption of renin-guided hypertension treatment. This resurgence of interest has occurred despite the fact that in the 30 plus years since Laragh's original work we still lack megatrials based on “hard” clinical endpoints to prove that the physiology based approach is superior. But, as one of the editorial writers points out, in other diseases endocrinologists have been relying on the physiologic approach for decades. Why not with hypertension?

H/T to Uremic Frost.

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