Renin activity in heart failure with reduced systolic function—new insights

Ryan D. Sullivan, Radhika M. Mehta, Ranjana Tripathi, Guy L. Reed, Inna P. Gladysheva

Research output: Contribution to journalReview articlepeer-review

28 Scopus citations


Regardless of the cause, symptomatic heart failure (HF) with reduced ejection fraction (rEF) is characterized by pathological activation of the renin–angiotensin–aldosterone system (RAAS) with sodium retention and extracellular fluid expansion (edema). Here, we review the role of active renin, a crucial, upstream enzymatic regulator of the RAAS, as a prognostic and diagnostic plasma biomarker of heart failure with reduced ejection fraction (HFrEF) progression; we also discuss its potential as a pharmacological bio-target in HF therapy. Clinical and experimental studies indicate that plasma renin activity is elevated with symptomatic HFrEF with edema in patients, as well as in companion animals and experimental models of HF. Plasma renin activity levels are also reported to be elevated in patients and animals with rEF before the development of symptomatic HF. Modulation of renin activity in experimental HF significantly reduces edema formation and the progression of systolic dysfunction and improves survival. Thus, specific assessment and targeting of elevated renin activity may enhance diagnostic and therapeutic precision to improve outcomes in appropriate patients with HFrEF.

Original languageEnglish (US)
Article number3182
JournalInternational journal of molecular sciences
Issue number13
StatePublished - Jul 1 2019


  • (pro)renin receptor
  • Aldosterone
  • Dilated cardiomyopathy
  • Direct rennin inhibitor
  • Heart failure
  • Plasma renin activity
  • Prorenin
  • Reduced systolic function
  • Renin
  • Renin–angiotensin–aldosterone system

ASJC Scopus subject areas

  • Catalysis
  • Molecular Biology
  • Spectroscopy
  • Computer Science Applications
  • Physical and Theoretical Chemistry
  • Organic Chemistry
  • Inorganic Chemistry


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