Using Renin Activity to Guide Mineralocorticoid Receptor Antagonist Therapy in Patients with Low-Renin Hypertension

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Key messages

• Primary aldosteronism is increasingly recognized as a significant cause of hypertension when the adrenal glands produce too much aldosterone.
• In most individuals aldosterone production is induced by the hormone renin, although many hypertensive patients with low renin experience renin-independent aldosterone overproduction.
• It is unknown whether mineralocorticoid receptor antagonist therapy is beneficial in patients with low-renin hypertension, which was investigated in this prospective observational study in 31 patients treated between 2005 and 2021.
• In patients who had renin levels unsuppressed after mineralocorticoid receptor blockade, there were significant decreases in blood pressure and urine protein.
• This suggests that suppressed renin may be sufficient to identify patients who could benefit from mineralocorticoid receptor blockade, and that dosing mineralocorticoid receptor antagonists to achieve unsuppressed renin may lower both blood pressure and proteinuria.