Diagnostic approach to low‐renin hypertension. (6th June 2018)

• Record Type: Journal Article
• Authors: Monticone, Silvia; Losano, Isabel; Tetti, Martina; Buffolo, Fabrizio; Veglio, Franco; Mulatero, Paolo
• Is Part Of: Clinical endocrinology. Volume 89:Number 4(2018)
• Page Start: 385
• Page End: 396
• Publication Date: 2018-06-06
• Subjects: hyperaldosteronism -- Liddle syndrome -- low‐renin hypertension -- plasma renin activity -- pseudohypoaldosteronism type 2; Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.13741
• Languages: English
• ISSNs: 0300-0664

Abstract

Summary: Renin‐angiotensin‐aldosterone system (RAAS) plays a crucial role in maintaining water and electrolytes homoeostasis, and its deregulation contributes to the development of arterial hypertension. Since the historical description of the "classical" RAAS, a dramatic increase in our understanding of the molecular mechanisms underlying the development of both essential and secondary hypertension has occurred. Approximatively 25% of the patients affected by arterial hypertension display low‐renin levels, a definition that is largely arbitrary and depends on the investigated population and the specific characteristics of the assay. Most often, low‐renin levels are expression of a physiological response to sodium‐volume overload, but also a significant number of secondary hereditary or acquired conditions falls within this category. In a context of suppressed renin status, the concomitant examination of plasma aldosterone levels (which can be inappropriately elevated, within the normal range or suppressed) and plasma potassium are essential to formulate a differential diagnosis. To distinguish between the different forms of low‐renin hypertension is of fundamental importance to address the patient to the proper clinical management, as each subtype requires a specific and targeted therapy. The present review will discuss the differential diagnosis of the most common medical conditions manifesting with a clinical phenotype of low‐renin hypertension, enlightening the novelties in genetics of the familial forms.