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Whether effects of diuretics on PRA differ according to class of diuretic, whether diuretics lead to a sustained increase in PRA, and whether changes in PRA relate to those in blood pressure (BP) is unknown. We performed a systematic review and meta\u2010analysis of trials investigating the antihypertensive effects of diuretic therapy in which PRA and\/or other biomarkers of fluid homeostasis were measured before and after treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Three databases were searched: MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials. Titles were firstly screened by title and abstract for relevancy before full\u2010text articles were assessed for eligibility according to a predefined inclusion\/exclusion criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1684 articles were retrieved of which 61 met the prespecified inclusion\/exclusion criteria. PRA was measured in 30\/61 studies. Diuretics led to a sustained increase in PRA which was similar for different classes of diuretic (standardised mean difference [95% confidence interval] 0.481 [0.362, 0.601], 0.729 [0.181, 1.28], 0.541 [0.253, 0.830] and 0.548 [0.159, 0.937] for thiazide, loop, mineralocorticoid receptor antagonists\/potassium\u2010sparing and combination diuretics respectively, Q = 0.897, <jats:italic>P<\/jats:italic> = .826), and did not relate to the average decrease in blood pressure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In antihypertensive drug trials, diuretics lead to a sustained increase in average PRA, which is similar across different classes of diuretic and unrelated to the average reduction in blood pressure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.14597","type":"journal-article","created":{"date-parts":[[2020,10,21]],"date-time":"2020-10-21T19:26:19Z","timestamp":1603308379000},"page":"2189-2198","source":"Crossref","is-referenced-by-count":14,"title":["Effect of diuretics on plasma renin activity in primary hypertension: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2395-183X","authenticated-orcid":false,"given":"Ryan J.","family":"McNally","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacology King's College London British Heart Foundation Centre  St. Thomas' Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Faconti","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology King's College London British Heart Foundation Centre  St. Thomas' Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Cecelja","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology King's College London British Heart Foundation Centre  St. Thomas' Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bushra","family":"Farukh","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology King's College London British Heart Foundation Centre  St. Thomas' Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9359-6381","authenticated-orcid":false,"given":"Christopher N.","family":"Floyd","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology King's College London British Heart Foundation Centre  St. Thomas' Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip J.","family":"Chowienczyk","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology King's College London British Heart Foundation Centre  St. Thomas' Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31293-0"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2003.010843"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajh.2011.171"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.42.3.376"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.005"},{"key":"e_1_2_8_7_1","volume-title":"Comprehensive Meta\u2010Analysis Version 3","author":"Borenstein M","year":"2013"},{"key":"e_1_2_8_8_1","volume-title":"Methods for Meta\u2010Analysis in Medical Research","author":"Sutton A","year":"2000"},{"key":"e_1_2_8_9_1","unstructured":"HigginsJPT ThomasJ ChandlerJ CumpstonM LiT PageMJ WelchVA.Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). 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