Elevated Plasma Renin Activity Predicts Adverse Outcome in Chronic Heart Failure, Independently of Pharmacologic Therapy: Data From the Valsartan Heart Failure Trial (Val-HeFT)

Background The prognostic value of plasma renin activity (PRA) in chronic heart failure (HF) has been assessed before the widespread use of angiotensin converting enzyme inhibitors (ACE) and beta blockers which exert opposite effects on rem secretion We evaluated the association between PRA and outcome in patients with chronic HF treated with ACEi and beta blockers Methods and Results PRA was measured in 4 291 patients from the Valsartan Heart Failure Trial (Val HeFT) The prognostic performance of PRA in patients who were or were not taking ACEi or beta blockers was evaluated by multivariable Cox models PRA was elevated in patients on ACEi (median 5 85 [in terquartile range (IQR) 1 82-17 83] ng/mL/h) compared with those not on ACE (1 57 [0 74-4 15] ng/mL/h) and lower in those on beta blockers (3 89 [1 17-12 61] ng/mL/h) than in those not on beta blockers (6 21 [1 97-19 24] ng/mL/h) Lower systolic blood pressure higher plasma aldosterone and ACE were associated with high PRA Higher PRA was a strong and independent predictor of mortality in the whole population and in patients who were or were not treated with ACE or beta blockers Conclusions PRA is a powerful prognostic marker of death over a wide range of concentrations in patients with chronic HF Prescription of ACE and/or beta blockers does not influence the relation between PRA and outcome (J Cardiac Fail 2010 16 964-970)