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Original Articles

Plasma Renin Activity and Hypertension in Diabetes Mellitus

  1. A Richard Christlieb, M.D.,
  2. Antoine Kaldany, M.D. and
  3. John A D'Elia, M.D.
  1. Joslin Clinic and the Elliott P. Joslin Research Laboratory Divisions of the Joslin Diabetes Foundation, the Department of Medicine, New England Deaconess and Peter Bent Brigham Hospitals, and Harvard Medical School Boston, Massachusetts
  1. Address reprint requests to Dr. Christlieb, 15 Joslin Road, Boston, Massachusetts 02215.
Diabetes 1976 Oct; 25(10): 969-974. https://doi.org/10.2337/diab.25.10.969
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Abstract

Plasma renin activity (PRA) was determined in 48 patients with diabetes mellitus in sodium balance on a 10-20 mEq. Na diet. Nine were normotensive (group I), 11 were hypertensive without diabetic nephropathy (group II), and 28 had hypertension and nephropathy (group III). Results were compared with those in 16 normal subjects and 49 nondiabetic patients with essential hypertension in similar Na balance. Mean supine PRA did not differ significantly among groups I and II, normal subjects, and patients with essential hypertension. Group III diabetics had a supine PRA of 2.4 ± 0.4 ng./ml./hr. (Embedded Image ± S.E.M.), significantly lower than the other diabetic groups (P < 0.005) and normal subjects (P < 0.05). Upright PRA was 12.8 ± 2.2 in group I diabetics, similar to that in normal subjects (13.3 ± 2.3), and 8.1 ± 1.4 in group II diabetics, similar to that in essential hypertensives (6.8 ± 0.8). In group III diabetics, upright PRA was 4.0 ± 0.5, significantly lower than that in any other group. These results suggest that (1) PRA is normal in normotensive diabetics, (2) upright PRA in diabetics with hypertension but no nephropathy is similar to that in essential hypertension, and (3) patients with diabetes, hypertension, and nephropathy have “low renin hypertension,” explaining the virtual absence of malignant hypertension in this group. Although the major mechanism for this low PRA may be volume expansion, indicating the need for potent diuretics, other mechanisms include hyalinization of the afferent arteriole, decreased cathecholamine stimulation of renin release, and inadequate conversion of prorenin to renin.

  • Accepted May 26, 1976.
  • Copyright © 1976 by the American Diabetes Association

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October 1976, 25(10)
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Plasma Renin Activity and Hypertension in Diabetes Mellitus
A Richard Christlieb, Antoine Kaldany, John A D'Elia
Diabetes Oct 1976, 25 (10) 969-974; DOI: 10.2337/diab.25.10.969

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Plasma Renin Activity and Hypertension in Diabetes Mellitus
A Richard Christlieb, Antoine Kaldany, John A D'Elia
Diabetes Oct 1976, 25 (10) 969-974; DOI: 10.2337/diab.25.10.969
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