From the Guidelines
Low renin states are characterized by decreased renin production, affecting the renin-angiotensin-aldosterone system, and are associated with resistant hypertension, hypokalemia, and increased cardiovascular risk, requiring specific treatment approaches, such as mineralocorticoid receptor antagonists, to address the underlying hormonal imbalances. These states can be primary or secondary and include conditions like primary aldosteronism, Liddle syndrome, and certain forms of hypertension. The significance of low renin states lies in their impact on blood pressure regulation and fluid balance, making them crucial to identify for proper treatment selection.
- Key characteristics of low renin states include:
- Hypertension that is often resistant to standard treatments
- Hypokalemia (low potassium)
- Metabolic alkalosis
- Increased cardiovascular risk
- Diagnosis involves measuring plasma renin activity and aldosterone levels, with a high aldosterone-to-renin ratio suggesting primary aldosteronism, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
- Treatment approaches for low renin states may include:
- Mineralocorticoid receptor antagonists, such as spironolactone (25-100 mg daily) or eplerenone (25-50 mg daily), for primary aldosteronism
- Potassium-sparing diuretics, such as amiloride (5-10 mg daily), for Liddle syndrome
- Calcium channel blockers or other specific treatments targeting the underlying cause
- Understanding the pathophysiological mechanisms of low renin states is essential for clinicians to select appropriate antihypertensive therapy and address the specific hormonal imbalances causing the condition, as highlighted in the resistant hypertension detection, evaluation, and management scientific statement from the American Heart Association 1.
From the FDA Drug Label
In a study in patients with low renin hypertension, blood pressure reductions in Blacks were smaller than those in whites during the initial titration period with eplerenone. The significance of low renin states is that they may affect the efficacy of certain antihypertensive treatments, such as eplerenone.
- Low renin hypertension is a condition where patients have lower than normal renin levels, which can impact blood pressure regulation.
- In patients with low renin hypertension, eplerenone may have varying effects on blood pressure reduction, depending on factors such as race 2.
From the Research
Definition and Prevalence of Low-Renin States
- Low-renin hypertension is a common condition, affecting approximately 1 in 4 people with hypertension 3
- It is characterized by low levels of renin, which can be due to various causes, including physiological responses to sodium-volume overload or secondary hereditary or acquired conditions 4
Significance of Low-Renin States
- Understanding the underlying pathophysiology of low-renin hypertension is crucial for individualized treatment 3
- Low-renin hypertension can be associated with primary aldosteronism (PA), a condition characterized by excessive production of aldosterone, leading to hypertension and cardiovascular morbidity 5, 6
- Renal function is often impaired in patients with low-renin hypertension, and treatment can help preserve renal function 6
Diagnosis and Treatment of Low-Renin States
- Diagnosis of low-renin hypertension involves measuring renin and aldosterone levels, as well as plasma potassium levels 4
- Treatment of low-renin hypertension depends on the underlying cause and may involve mineralocorticoid receptor antagonists (MRAs) such as spironolactone or eplerenone 5, 6, 7
- MRAs can help reduce blood pressure, left-ventricular hypertrophy, and urinary albumin excretion in patients with essential hypertension or primary aldosteronism 7