Plasma renin activity in patients with heart failure and reduced ejection fraction on optimal medical therapy

Petra Nijst, Frederik H. Verbrugge, Pieter Martens, Philippe B. Bertrand, Matthias Dupont, Gary S. Francis, W. H.Wilson Tang, Wilfried Mullens

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Renin-angiotensin-aldosterone system (RAAS) activation in heart failure with reduced ejection fraction (HFREF) is detrimental through promotion of ventricular remodeling and salt and water retention. Aims: The aims of this article are to describe RAAS activity in distinct HFREF populations and to assess its prognostic impact. Methods: Venous blood samples were prospectively obtained in 76 healthy volunteers, 72 patients hospitalized for acute decompensated HFREF, and 78 ambulatory chronic HFREF patients without clinical signs of congestion. Sequential measurements were performed in patients with acute decompensated HFREF. Results: Plasma renin activity (PRA) was significantly higher in ambulatory chronic HFREF (7.6 ng/ml/h (2.2; 18.1)) compared to patients with acute decompensated HFREF (1.5 ng/ml/h (0.8; 5.7)) or healthy volunteers (1.4 ng/ml/h (0.6; 2.3)) (all p < 0.05). PRA was significantly associated with arterial blood pressure and renin-angiotensin system blocker dose. A progressive rise in PRA (+4 ng/ml/h (0.4; 10.9); p < 0.001) was observed in acute decompensated HFREF patients after three consecutive days of decongestive treatment. Only in acute HFREF were PRA levels associated with increased cardiovascular mortality or HF readmissions (p = 0.035). Conclusion: PRA is significantly elevated in ambulatory chronic HFREF patients but is not associated with worse outcome. In contrast, in acute HFREF patients, PRA is associated with cardiovascular mortality or HF readmissions.

Original languageEnglish (US)
JournalJRAAS - Journal of the Renin-Angiotensin-Aldosterone System
Issue number3
StatePublished - Jul 2017
Externally publishedYes

Bibliographical note

Funding Information:
P. N., F.H.V., P.M. and W.M. are researchers for the Limburg Clinical Research Program (LCRP) UHasselt–ZOL–Jessa, supported by the foundation Limburg Sterk Merk (LSM), Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. F.H.V. and P.B.B. are supported by a PhD fellowship of the Research Foundation–Flanders (FWO). P.N. and M.D. are supported by a research grant provided by Vision4Life-Sciences.

Publisher Copyright:
© The Author(s) 2017.


  • Aldosterone
  • Biomarkers
  • Renin
  • Renin-angiotensin system
  • Systolic heart failure


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