Hypertension is Caused by Elevated Renin Levels:
Dr. Laragh says that common hypertension is caused by excess renin in sixty percent of cases and can be permanently controlled with one drug by measuring blood renin activity, a procedure that Dr. Laragh pioneered and perfected over thirty years at his lab. This test is called the PRA test (plasma renin activity). As a hospital based interventional radiologist for over 25 years, I sometimes did renin measurements by placing small catheters into each renal vein and collecting blood samples from the kidneys. (6) This is unnecessary for most people, because a routine blood sample from an arm vein is all that is needed to run the PRA test.
Left Image: molecular structure of renin, Courtesy of Wikipedia
We also used captopril renography to identify patients with renal artery stenosis who would benefit from renal artery angioplasty (7)
Two types of Essential Hypertension:
Low Renin Hypertension
Dr Laragh says that essential hypertension exists in two forms. The first form is low renin hypertension, occuring in about a third of hypertensives. This is called Volume (V) hypertension. The plasma rennin activity PRA test shows low renin (less than 0.65 ng/m/hr) and the "water pills" such as the thiazides and calcium channel blockers work best for this type of low renin hypertension.
The most commonly used pills in this calcium channell blocker category is Norvasc (amlodipine).
The most commonly used diuretic is Hygroton (hydrochlorothiazide)
High Renin Hypertension
The second type is high renin hypertension, occurring in the other two thirds of hypertensives, is labeled (R) for Renin Hypertension, and the PRA levels are greater than 0.65 ng/m/hr. This hypertension is due to the renin-angiotensin system, and the newer drugs such as the ACE Inhibitors (angiotensin converting enzyme inhibitors) and Beta Blockers work best for this type.
The most commonly used Ace Inhibitor drug is Lisinopril.
Common Beta Blockers are: Atenolol (Tenormin), Metoprolol (Lopressor, Toprol-XL) and Propranolol (Inderal)
Measuring renin allows your doctor to identify which type of antihypertensive medication is most likely to be effective and possibly safer for you. If the "water pills" have been tried and dont work for you, then you are probably have high renin hypertension and need one of the newer drugs such as an Ace Inhibitor. The advantage here is that once this is established, it is possible for you have your blood pressure controlled with one drug permanently. Single drug therapy for life is the major goal of treatment.
Problems with older "water pills":
Whats really worrisome is the harm that can result from traditional diuretic "water pills". The thiazide diuretic, hygroton, produced an 11 percent incidence of permanent diabetes over five years in the ALLHAT drug study.(8)(9) Diabetes is a super high risk factor for heart disease. In other studies, thiazide "water pills" have been shown to regularly produce potassium and magnesium depletion that leads to cardiac arrhythmias, muscle weakness, EKG changes and fatal heart problems. All of these thiazide "water pill complications can be avoided by using a spirolactone type water pill instead (called aldactone). Spironolactone is off-patent and therefore inexpensive costing 22 cents per tablet. The aldactone corrects the sodium-volume related hypertension without ever causing diabetes or depletion of potassium and magnesium. An incidental side effect of spironolactone is that this drug has an anti-testosterone effect. This may be useful in young females with PCOS and high testosterone levels, however, this may contribute to gynecomastia (breast enlargement) in aging males.
It hard to understand why Dr. Laragh's information has been overlooked (if not deliberately omitted) in official recommendations for the treatment of hypertension. And as a result, your doctor may not do the renin test for high blood pressure unless you bring it up.
Alternatives to Drug treatment: Coenzyme Q-10 and Nattokinase:
Co-Enzyme Q-10 is a vitamin like nutritional supplement that has been useful in eliminating the need for blood pressure medications in about half the people who try it.(10)(11) One such program is advocated by Stephen Sinatra, M.D. in his books, "The Sinatra Solution, Metabolic Cardiology" and "Lower Your Blood Pressure in 8 weeks".(12)
Co-Enzyme Q-10 has also been credited with saving many people from death from congestive heart failure when other drugs have failed. In addition, since the statin anti-cholesterol drugs cause depletion of Co-Enzyme Q-10 in the body, all patients on a statin drug should be supplementing with Co-Enzyme Q-10. Since Co-Q10 is not a drug, your doctor may not be aware of it.
The Benefits of Nattokinase on Blood Pressure
In 1980, while studying physiological chemistry at the University of Chicago Medical School, Japanese researcher Hiroyuki Sumi accidentally discovered that a traditional Japanese soy cheese which had been consumed for centuries, called "natto", had the ability to dissolve clots. His research group published a paper on the discovery in 1987.(13)
Above image: Sphyngomanometer for measuring blood pressure, courtesy of wikimedia.
Traditionally, Natto has been consumed not only for cardiovascular support, but also to lower blood pressure. This was confirmed by several clinical trials in 1995, at Miyazaki Medical College and Kurashiki University in Japan where the effects of nattokinase on blood pressure in both animal and human subjects was studied. The researchers found that natto inhibits angiotensin converting enzyme (ACE), which has a lowering effect on blood pressure. In one Human Study, Nattokinase ingestion was associated with a 10 percent drop in blood pressure. Natto is a nutritional supplement which is considered safe, However, people with bleeding disorders or on blood thinners should use nattokinase only under medical supervision. (14)(15)(16)
Check your own blood pressure:
If you are not sure what you blood pressure number is, you can have your doctor check it, or you can check it yourself with your own inexpensive machine obtainable from most drug stores. The normal blood pressure is commonly stated as 120 over 80 mm Hg.
Articles with Related Interest
Blood Pressure, When to Treat ?
Jeffrey Dach MD
7450 Griffin Road Suite 190
Davie Fl 33314
JULY 8, 2003 PREVALENCE OF HYPERTENSION INCREASING IN THE U.S.— Nearly one-third of the U.S. adult population, an estimated 58 million people, have hypertension, an increase from previous reports, and reversing a three decade decline in the prevalence rate, according to a study in the July 9 issue of The Journal of the American Medical Association (JAMA). Hypertension was defined as a measured blood pressure (BP) of 140/90 mm Hg or greater or reported use of antihypertensive medications.
Trends in Prevalence, Awareness, Treatment, and Control of Hypertension in the United States, 1988-2000 Ihab Hajjar, MD, MS; Theodore A. Kotchen, MD JAMA. 2003;290:199-206.
Conclusions Contrary to earlier reports, hypertension prevalence is increasing in the United States. Hypertension control rates, although improving, continue to be low. Programs targeting hypertension prevention and treatment are of utmost importance.
John Laragh MD, CV and publication list. Cornell University
John Laragh MD Cover of Time Magazine credited to Bill Pierce Jan 13, 1975
Time Magazine article on John Laragh and Hypertension, CONQUERING THE QUIET KILLER Monday, Jan. 13, 1975
Hypertension and renovascular disease: follow-up on 100 renal vein renin samplings. P Hasbak1, L T Jensen and H Ibsen. Journal of Human Hypertension, April 2002, Volume 16, Number 4, Pages 275-280
Procedure Guideline for Diagnosis of Renovascular Hypertension, Andrew T. Taylor, Jr. et al. J Nucl Med. 1998 Jul;39(7):1297-302.
Water Pills Help All With Hypertension By Sid Kirchheimer WebMD Feature Reviewed By Charlotte Grayson
Water Pills Increase Diabetes Risk in Major Study. Diuretics More Likely To Cause Diabetes Then ACE Inhibitors Or Calcium Channel Blockers. Patients randomized to diuretics in the landmark ALLHAT were more likely to develop new onset diabetes than patients randomized to either a calcium channel blocker or an angiotensin-converting enzyme (ACE) inhibitor to control high blood pressure, according to results But Dr. Joshua Barzilay,
Coenzyme Q-10 Page at the Linus Pauling Inst.
J Hum Hypertens. 1999 Mar;13(3):203-8.
Effect of hydrosoluble coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with coronary artery disease.Singh RB, Niaz MA, Rastogi SS, Shukla PK, Thakur AS.
Dr. Steven Sinatra Web Site:
Nattokinase and Serrapeptase: Nature’s Clot-Busters James South, M.A.
Nattokinase research at Mercola.com
Nattokinase at Smart Punlications, Links to abstracts
Jeffrey Dach MD
7450 Griffin Road Suite 190
Davie Fl 33314
The reader is advised to discuss the comments on these pages with his/her personal physicians and to only act upon the advice of his/her personal physician Also note that concerning an answer which appears as an electronically posted question, I am NOT creating a physician -- patient relationship. Although identities will remain confidential as much as possible, as I can not control the media, I can not take responsibility for any breaches of confidentiality that may occur. Finally, the material produced by myself may be reproduced for personal use, provided that appropriate credit is given.
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Title: Fifty Million Americans have High Blood Pressure by Jeffrey Dach MD