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Approximately 30% of hypertensive patients have low renin concentrations. Measurement of renin and aldosterone is the key to diagnosing low-renin hypertension and confirming the phenotype. It occurs because of inherited genetic syndromes, acquired somatic mutations and endogenous and exogenous factors. Therapy depends on the subtype of low-renin hypertension. Primary aldosteronism is the leading cause of secondary hypertension worldwide and is the main form of low-renin hypertension. Its harmful effects outstrip those due to blood pressure elevation alone. Surgical intervention may sometimes result in a complete cure, obviating the need for lifelong antihypertensive treatment. This review will discuss the main factors responsible for an accurate differential diagnosis of low-renin hypertension. [ABSTRACT FROM AUTHOR]