If young people have high blood pressure, it may be due to elevated "renin". What should we do?

A friend in his 30s told Huazi that his high blood pressure was normal, less than 130 mmHg, but his low blood pressure was high, often around 100 mmHg, and the difference between the high and low blood pressure was very small. He measured his heart rate and it was more than 70 beats per minute, which was not fast. He was in a good mood and had no anxiety. He was not fat and did not know why he had high blood pressure.

Huazi told him that 95% of people with hypertension have primary hypertension, and the current medical technology has not yet found the cause. However, primary hypertension usually occurs in the middle-aged and elderly people. If young people have hypertension, if mental stress and obesity are excluded, then it may also be due to high renin levels.

1. What is Renin

Renin is an enzyme released by the juxtaglomerular apparatus that catalyzes the conversion of angiotensinogen secreted by the liver into angiotensin 1 and increases the production of aldosterone.

Under the action of angiotensin converting enzyme, angiotensin 1 generates angiotensin 2, which is then hydrolyzed into angiotensin 3. These three types of angiotensin have the effect of constricting blood vessels and raising blood pressure, and angiotensin 2 has the strongest effect.

The effect of aldosterone can increase the reabsorption of sodium ions and water by the renal tubules, thereby increasing blood volume and the sodium ion concentration in the extracellular environment, causing blood pressure to rise.

The renin-angiotensin-aldosterone system (RAAS) is an important blood pressure regulation mechanism in the human body. The more renin is released, the higher the blood pressure will be.

2. Various factors can affect the release of renin

1. Renal artery stenosis: When the renal artery is stenotic, the blood volume of the afferent arterioles decreases, which activates the stretch receptors in the arterial wall, excites the sympathetic nerves, and increases the release of renin. When the blood flow decreases, the glomerular filtration rate also decreases, and the sodium ion concentration decreases, which also excites the sympathetic nerves and increases the release of renin.

2. Kidney disease and tumors: If you have kidney disease and renal insufficiency, which leads to an increase in blood creatinine levels, it will also promote an increase in renin release. Or if you suffer from kidney tumors, pheochromocytoma and other diseases, it will also cause excessive renin secretion.

3. Mental factors: When you are nervous, anxious, stressed, or encounter major emotional changes, it will also cause increased renin secretion.

3. What to do if renin is elevated

The renin activity level can be tested in the hospital. If it is found to be elevated, relevant examinations such as renal color Doppler ultrasound and renal angiography should be performed to see if there is renal parenchymal lesions or renal artery stenosis. If so, targeted treatment is needed.

In terms of medication, both prils and sartans can be used for hypertension caused by elevated renin. Prils can inhibit angiotensin-converting enzyme and reduce the production of angiotensin 2; sartans can inhibit the binding of angiotensin 2 to receptors on blood vessels. Both drugs can inhibit RAAS and produce a hypotensive effect.

Although prils have a better protective effect on cardiovascular disease, they are prone to cause dry cough. For young and middle-aged hypertension, there is no need for cardiovascular protection, so sartans are used more. If the effect of single-drug treatment is not good, you can consider combining it with dihydropyridine drugs.

When taking the medicine, please note that the mechanism of action of prils and sartans is similar. The two can replace each other, but cannot be used in combination. Bilateral renal artery stenosis is a common contraindication for both drugs. Acute renal failure may occur after taking the medicine, so be careful to avoid using it.

To sum up, if young people have high blood pressure, their heart rate is normal and they are not obese, they need to consider whether their renin levels are elevated. It is recommended to test the renin activity level and check whether the renal parenchyma and blood vessels have lesions. When taking antihypertensive drugs, you need to use them under the guidance of a doctor. If you have any questions about the medication, you should consult a doctor or pharmacist in time. I am pharmacist Huazi. Welcome to follow me and share more health knowledge.