Renin-Guided Risk Stratification and Therapy in Hypertension to Reduce Major Adverse Cardiovascular Outcomes

BackgroundRisk stratification in hypertension remains challenging. The prognostic value of plasma renin in guiding therapy for hypertension is not well established. MethodsIn this multicenter retrospective cohort of 16,600 people with hypertension, we evaluated the association between plasma renin activity and major adverse cardiovascular events (MACE) defined as stroke, myocardial infarction, and all-cause death. Plasma renin was analyzed as a continuous variable using restricted cubic splines. A 6-month landmark analysis assessed treatment effects of mineralocorticoid receptor antagonists (MRA) as opposed to baseline renin-angiotensin system inhibitors. ResultsContinuous renin level showed