Diagnostic approach to low-renin hypertension

Clin Endocrinol (Oxf). 2018 Oct;89(4):385-396. doi: 10.1111/cen.13741. Epub 2018 Jun 6.


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.

Keywords: Liddle syndrome; hyperaldosteronism; low-renin hypertension; plasma renin activity; pseudohypoaldosteronism type 2.

Publication types

  • Review

MeSH terms

  • Animals
  • Humans
  • Hyperaldosteronism / blood
  • Hyperaldosteronism / diagnosis
  • Hyperaldosteronism / metabolism
  • Hypertension / blood
  • Hypertension / diagnosis*
  • Hypertension / metabolism*
  • Liddle Syndrome / blood
  • Liddle Syndrome / diagnosis
  • Liddle Syndrome / metabolism
  • Renin / blood
  • Renin / metabolism*


  • Renin