Angiotensin peptide and aldosterone concentrations in response to four classes of blood-pressure-lowering drugs in hypertensive patients: A randomized trial
In brief
Blood markers distinguished ACE inhibitor and ARB use after 4 weeks
In a randomized trial, 72 patients completed 4 weeks of treatment, and ACE inhibitors and angiotensin receptor blockers produced distinct patterns in blood angiotensin peptides. An ACE activity marker identified ACE inhibitor use, while an aldosterone-to-angiotensin II ratio and angiotensin II level identified ARB use. The study supports further testing of these markers for monitoring medication intake, but did not establish their value in routine care.
- Journal
- Journal of human hypertension (Q2)
- Published
- 12 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Vera van der Velpen, Franziska Küng, Andrea Villiger, Marko Poglitsch, Robin Finch, Urs Duthaler, et al.
- PMID
- 42864373
- DOI
- 10.1038/s41371-026-01239-1
Why clinicians should know about it
- Picked for Biochemistry (medical) (top studies of the week, 18 October 2026): Angiotensin peptide profiling, LC‑MS biomarker assay
Abstract
The renin angiotensin aldosterone system (RAS) regulates blood pressure and fluid balance by a cascade of angiotensin (Ang) peptides. Antihypertensive drug classes differentially modulate this cascade. This study examined how four mechanistically distinct antihypertensive drugs affect plasma concentrations of 10 Ang peptides and aldosterone in untreated hypertensive patients. In this randomized, open-label, parallel-group study, 88 patients received 4 weeks of monotherapy with angiotensin-converting enzyme inhibitor (ACEi), angiotensin receptor blocker (ARB), calcium channel blocker (CCB), or hydrochlorothiazide (HCT). Equilibrium concentrations of 10 Ang peptides and aldosterone were quantified by LC-MS at baseline and after 4 weeks, both pre- and 4 h post-dose; drug exposure was confirmed by measured drug concentrations. Seventy-two participants completed the 4-week treatment (ACEi n = 18, ARB n = 17, CCB n = 20, HCT n = 17). The most prominent effects were seen for Ang I, Ang II, and aldosterone and were reflected in biomarkers for plasma renin activity (PRA-Q; Ang I+Ang II), ACE activity (ACE-Q; Ang II/Ang I), and the aldosterone/Ang II ratio (AA2-R). Downstream peptides showed minimal or no changes. Relative to baseline, ACEi increased Ang I and reduced ACE-Q. ARB increased Ang I and Ang II and lowered AA2-R without altering ACE-Q. CCB and HCT produced only minor changes. ACE-Q < 1.05 pM/pM identified ACEi use, and AA2-R < 0.85 pM/pM as well as Ang II > 175 pM identified ARB use. RAS-targeted monotherapy produces distinct peptide-level signatures that can be captured by Ang-derived biomarkers, supporting their potential utility for monitoring drug intake in personalized hypertension management.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.