Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Low-renin essential (primary) hypertension

INTRODUCTION

Renin-sodium profiling in patients with essential (primary) hypertension reveals that the plasma renin activity (PRA) is increased in 15 percent, normal in 60 percent, and reduced in approximately 25 percent [1]. Low renin levels are found more frequently in blacks and in the elderly [2].

Although it is likely that patients with low-renin essential hypertension (LREH) represent part of a continuum of hypertensives, this subgroup may have some relatively unique characteristics:

  • The elevation in blood pressure is more likely to be salt-sensitive [3].
  • The response to nonpharmacologic therapy, particularly weight reduction, may be less pronounced [4].
  • The antihypertensive response may be greatest with a diuretic or calcium channel blocker [1,3,5].

This topic will review issues related to low renin essential hypertension. The general evaluation of patients with hypertension is presented separately. (See "Initial evaluation of the hypertensive adult".)

PATHOGENESIS

A higher perfusion pressure at the juxtaglomerular cell that may be seen in essential hypertension would be expected to lead to suppression of renin release and low levels of PRA. This is supported by the observation that some patients with essential hypertension tend to have lower PRA levels than age- and gender-matched normotensive individuals. However, the majority of patients with primary hypertension do not have low renin levels [1].
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2010 UpToDate, Inc.
References Top
  1. Bühler, FR, Bolli, P, Kiowski, W, et al. Renin profiling to select antihypertensive baseline drugs. Am J Med 1984; 77(2A):36.
  2. Sagnella, GA. Why is plasma renin activity lower in populations of African origin?. J Hum Hypertens 2001; 15:17.
  3. Laragh, JH, Resnick, LM. Recognizing and treating two types of long-term vasoconstriction in hypertension. Kidney Int Suppl 1988; 25:S162.
  4. Blaufox, MD, Lee, HB, Davis, B, et al. Renin predicts the blood pressure response to nonpharmacologic and pharmacologic therapy. JAMA 1992; 267:1221.
  5. Bühler, FR. Calcium antagonists as first-choice therapy for low-renin essential hypertension. Kidney Int 1989; 36:295.
  6. Mackenzie, IS, Brown, MJ. Molecular and clinical investigations in patients with low-renin hypertension. Clin Exp Nephrol 2009; 13:1.
  7. Hood, SJ, Taylor, KP, Ashby, MJ, Brown, MJ. The spironolactone, amiloride, losartan, and thiazide (SALT) double-blind crossover trial in patients with low-renin hypertension and elevated aldosterone-renin ratio. Circulation 2007; 116:268.
  8. Funder, JW, Carey, RM, Fardella, C, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93:3266.
  9. Rossi, E, Regolisti, G, Perazzoli, F, et al. -344C/T polymorphism of CYP11B2 gene in Italian patients with idiopathic low renin hypertension. Am J Hypertens 2001; 14:934.
  10. Johnston, CI. Franz Volhard Lecture. Renin-angiotensin system: A dual tissue and hormonal system for cardiovascular control. J Hypertens Suppl 1992; 10(7):S13.
  11. Seikaly, MG, Arant, BS, Jr, Seney, FD, Jr. Endogenous angiotensin concentrations in specific intrarenal fluid compartments of the rat. J Clin Invest 1990; 86:1352.
  12. Redgrave, J, Rabinowe, S, Hollenberg, NK, Williams, GH. Correction of abnormal renal blood flow response to angiotensin II by converting enzyme inhibition in essential hypertension. J Clin Invest 1985; 75:1285.
  13. Bachmann, S, Peters, J, Engler, E, et al. Transgenic rats carrying the mouse renin gene — morphologic characterization of a low-renin hypertension model. Kidney Int 1992; 41:24.
  14. Buhler, FR, Laragh, JH, Baer, L, et al. Propranolol inhibition of renin secretion. A specific approach to diagnosis and treatment of renin-dependent hypertensive diseases. N Engl J Med 1972; 287:1209.
  15. Alderman, MH, Madhavan, S, Ooi, WL, et al. Association of the renin-sodium profile with the risk of myocardial infarction in patients with hypertension. N Engl J Med 1991; 324:1098.
  16. Meade, TW, Cooper, JA, Peart, WS. Plasma renin activity and ischemic heart disease. N Engl J Med 1993; 329:616.
  17. Wyndham, RN, Gimenez, L, Walker, WG, et al. Influence of renin levels on the treatment of essential hypertension with thiazide diuretics. Arch Intern Med 1987; 147:1021.
  18. Weinberger, MH, White, WB, Ruilope, LM, et al. Effects of eplerenone versus losartan in patients with low-renin hypertension. Am Heart J 2005; 150:426.
  19. Sassano, P, Chatellier, G, Billaud, E, et al. Treatment of mild to moderate hypertension with or without the converting enzyme inhibitor enalapril. Results of a six-month double-blind trial. Am J Med 1987; 83:227.
  20. Azizi, M, Bissery, A, Bura-Riviere, A, Menard, J. Dual renin-angiotensin system blockade restores blood pressure-renin dependency in individuals with low renin concentrations. J Hypertens 2003; 21:1887.
  21. Weir, MR, Saunders, E. Renin status does not predict the anti-hypertensive response to angiotensin-converting enzyme inhibition in African-Americans. Trandolapril Multicenter Study Group. J Hum Hypertens 1998; 12:189.
  22. Laragh, JH, Sealey, JE. Relevance of the plasma renin hormonal control system that regulates blood pressure and sodium balance for correctly treating hypertension and for evaluating ALLHAT. Am J Hypertens 2003; 16:407.
white circle LOG IN
white circle DEMO