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Low-renin hypertension.

Paolo Mulatero1, Silvia Monticone1, Jessica Goi1

  • 1Department of Medical Sciences, Internal Medicine Division and Hypertension Unit, University of Torino. Torino, Italy.

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|February 4, 2026
PubMed
Summary
This summary is machine-generated.

Low-renin hypertension (LRH) encompasses diverse conditions causing high blood pressure with low renin. Identifying specific subtypes is crucial for effective, targeted treatments and improved cardiovascular outcomes.

Keywords:
AldosteroneLiddle syndromeLow-renin hypertensionMineralocorticoid receptorRenin

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Area of Science:

  • Nephrology
  • Endocrinology
  • Cardiovascular Medicine

Background:

  • Low-renin hypertension (LRH) affects 30% of hypertensive patients, presenting as a heterogeneous group of disorders.
  • Key features include low renin levels, increased sodium reabsorption, and expanded circulating volume.
  • LRH encompasses essential hypertension and various secondary causes, including primary aldosteronism and monogenic disorders.

Purpose of the Study:

  • To describe the differential diagnosis and underlying mechanisms of common LRH conditions.
  • To focus on diagnostic and therapeutic strategies for LRH subtypes.
  • To highlight the therapeutic implications of recognizing specific LRH phenotypes.

Main Methods:

  • Clinical evaluation, including family history.
  • Biochemical measurements: renin, aldosterone, and potassium levels.
  • Genetic profiling for monogenic forms.

Main Results:

  • Primary aldosteronism is the most common secondary cause of LRH.
  • Monogenic forms like Liddle syndrome and apparent mineralocorticoid excess have distinct profiles.
  • Acquired causes include high sodium intake, renal disease, RAAS inhibitors, and licorice/cortisol excess.
  • Mineralocorticoid receptor activation and increased sodium reabsorption are common pathogenic mechanisms.

Conclusions:

  • Accurate diagnosis of LRH subtypes is essential for tailored treatment.
  • Recognizing specific LRH conditions improves long-term outcomes and reduces cardiovascular events.
  • Understanding the continuum between essential and secondary LRH forms guides therapeutic approaches.