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Heart 1998;80:45-48; doi:10.1136/hrt.80.1.45
Copyright © 1998 BMJ Publishing Group Ltd & British Cardiovascular Society

Heart 1998;80:45-48 ( July )

beta Adrenergic blockers lower renin in patients treated with ACE inhibitors and diuretics

S R Holmer,a H-W Hense,b A H J Danser,c B Mayer,a G A J Riegger,a H Schunkerta

a Klinik und Poliklinik für Innere Medizin II, University of Regensburg, D 93042 Regensburg, Germany, b Institut für Epidemiologie und Sozialmedizin, Universität Münster, Münster, and GSF München, Germany, c Departments of Pharmacology and Internal Medicine, Erasmus University, Rotterdam, Netherlands

Correspondence to: Dr Holmer.

Accepted for publication 22 January 1998

Objective---To examine the effect of concomitant intake of beta  blockers with angiotensin converting enzyme (ACE) inhibitors, diuretics, or both on plasma renin concentrations in a population based sample (MONICA survey, Augsburg, Germany).
Subject and methods---728 individuals were studied, of whom 171 were treated using monotherapy (ACE inhibitor (n = 21), diuretic (n = 10), or beta  blocker (n = 72)), or combination treatment (ACE inhibitor + diuretic (n = 32), ACE inhibitor + beta  blocker (n = 7), diuretic + beta  blocker (n = 22), ACE inhibitor + diuretic + beta  blocker (n = 7)). The remaining 557 individuals were untreated. Indications for treatment were hypertension (75%), coronary artery disease with (12%) or without (3%) hypertension, or unknown (10%).
Results---Mean (SEM) renin concentrations in individuals treated with an ACE inhibitor (41 (8) mU/l), a diuretic (41 (10) mU/l), or the combination of an ACE inhibitor and a diuretic (54 (10) mU/l) were raised compared with untreated individuals (17 (1) mU/l; p < 0.05 each). Monotherapy with a beta  blocker, however, decreased mean renin concentrations (12 (1) mU/l; p < 0.01 v untreated). Renin concentrations in individuals taking a beta  blocker with either an ACE inhibitor (21 (8) mU/l), or a diuretic (22 (4) mU/l), or with both an ACE inhibitor and a diuretic (21 (7) mU/L), were significantly lower compared with renin concentrations in groups not receiving beta  blocker treatment (p < 0.05 each).
Conclusion---These data suggest that the upregulation of renin by treatment with ACE inhibitors, diuretics, or both can be largely prevented by concomitant beta  blocker treatment.

Keywords: adrenergic beta  receptor blocker;  angiotensin converting enzyme inhibitor;  renin;  hypertension

© 1998 by Heart
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