From the Guidelines
No, low renin hypertension and high renin hypertension cannot occur simultaneously in the same individual, as they represent distinct pathophysiological states with different underlying mechanisms and treatment approaches. The renin-angiotensin-aldosterone system (RAAS) plays a crucial role in regulating blood pressure, and an individual's renin status is a key determinant of their hypertension subtype. According to the 2018 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, the diagnosis and management of hypertension involve assessing renin status and tailoring treatment accordingly. Low renin hypertension is often associated with excess mineralocorticoids, salt sensitivity, or certain endocrine disorders, and typically responds well to calcium channel blockers or thiazide diuretics. In contrast, high renin hypertension involves elevated renin levels driving the hypertension, and often responds better to ACE inhibitors, ARBs, or direct renin inhibitors that target the elevated renin-angiotensin activity. The British Hypertension Society guidelines for hypertension management also support this approach, recommending the use of a treatment algorithm based on the AB/CD rule to inform the better use of logical combinations of drugs 1.
Some key points to consider in the management of hypertension include:
- Assessing renin status to determine the underlying pathophysiological mechanism driving the hypertension
- Tailoring treatment approaches based on renin status, with low renin hypertension often responding well to calcium channel blockers or thiazide diuretics, and high renin states typically responding better to ACE inhibitors, ARBs, or direct renin inhibitors
- Using a treatment algorithm, such as the AB/CD rule, to inform the selection of antihypertensive agents and minimize the risk of adverse effects
- Considering lifestyle modifications, such as limiting alcohol intake and discontinuing or decreasing the dose of certain medications, to help manage hypertension 1.
Overall, the management of hypertension requires a nuanced understanding of the underlying pathophysiological mechanisms and a tailored approach to treatment, taking into account the individual's renin status and other relevant factors.
From the Research
Low Renin Hypertension and High Renin Hypertension
- The provided studies do not directly address whether low renin hypertension can happen at the same time as high renin hypertension 2, 3, 4, 5, 6.
- Low renin hypertension is a common condition, affecting 1 in 4 people with hypertension, and its management requires understanding the underlying pathophysiology to individualize treatment 2.
- The renin-angiotensin-aldosterone system plays a crucial role in maintaining water and electrolytes homoeostasis, and its deregulation contributes to the development of arterial hypertension 6.
- Low renin levels can be an expression of a physiological response to sodium-volume overload, but also a significant number of secondary hereditary or acquired conditions falls within this category 6.
- The concomitant examination of plasma aldosterone levels and plasma potassium is essential to formulate a differential diagnosis in a context of suppressed renin status 6.
- There is no direct evidence in the provided studies to suggest that low renin hypertension and high renin hypertension can coexist simultaneously, and further research is needed to understand the relationship between these two conditions.