BETA-ADRENERGIC BLOCKERS LOWER RENIN IN PATIENTS TREATED WITH ACE-INHIBITORS AND DIURETICS

Objective-To examine the effect of concomitant intake of beta blockers with angiotensin converting enzyme (ACE) inhibitors, diuretics, or bo th 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 tr eatment (ACE inhibitor + diuretic (n = 32), ACE inhibitor + beta block er (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 di sease with (12%) or without (3%) hypertension, or unknown (10%). Resul ts-Mean (SEM) renin concentrations in individuals treated with an ACE inhibitor (41 (8)mU/1), a diuretic (41 (10) mU/1), or the combination of an ACE inhibitor and a diuretic (54 (10) mU/1) were raised compared with untreated individuals (17 (1) mU/1; p < 0.05 each). Monotherapy with a beta blocker, however, decreased mean renin concentrations (12 (1) mU/1; p < 0.01 upsilon untreated). Renin concentrations in individ uals taking a beta blocker with either an ACE inhibitor (21 (8) mU/1), or a diuretic (22 (4) mU/1), or with both an ACE inhibitor and a diur etic (21 (7)mU/L), were significantly lower compared with renin concen trations in groups not receiving beta blocker treatment (p < 0.05 each ). Conclusion-These data suggest that the upregulation of renin by tre atment with ACE inhibitors, diuretics, or both can be largely prevente d by concomitant beta blocker treatment.