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Diagnostic approach to low‐renin hypertension
Author(s) -
Monticone Silvia,
Losano Isabel,
Tetti Martina,
Buffolo Fabrizio,
Veglio Franco,
Mulatero Paolo
Publication year - 2018
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13741
Subject(s) - renin–angiotensin system , plasma renin activity , medicine , essential hypertension , context (archaeology) , aldosterone , pathophysiology of hypertension , secondary hypertension , homeostasis , concomitant , differential diagnosis , endocrinology , bioinformatics , cardiology , biology , blood pressure , pathology , paleontology
Summary 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.