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Low-renin hypertension is common and affects 1 in 4 people with hypertension. Understanding the different causes and management of low-renin hypertension is becoming increasingly relevant as renin measurements are more widely ordered in clinical practice. Importantly, many people with low-renin hypertension do not fit traditional definitions of known causes, and the approach to management of these people is not unclear. This review provides an overview of our evolving understanding of the causes of low-renin hypertension, the expanding spectrums of pathophysiology, key differentiating characteristics, distinct management strategies, and highlights our knowledge gaps. It is important to distinguish the underlying pathophysiology of an individual with low-renin hypertension to individualize treatment. [ABSTRACT FROM AUTHOR]

This article discusses the prevalence and characteristics of low-renin hypertension in a primary care population. It states that approximately 1 in 4 people with hypertension have low renin, but most do not meet the criteria for primary aldosteronism or have a monogenetic cause. The study found that people with low-renin hypertension with no apparent cause are more likely to be older, female, and have lower aldosterone concentration. The article also mentions the term "Liddle-like syndrome" used by Professor Spence to refer to the high prevalence of the low renin/low aldosterone phenotype in other cohorts. It emphasizes that low-renin "essential" hypertension encompasses several disease processes and potential underlying causes. The study did not explore optimal management for this cohort but suggests that mineralocorticoid receptor antagonists may be a reasonable first-line option. The article acknowledges the possible role of gene polymorphisms in those with low-renin/aldosterone phenotype but notes that more research is needed to accurately characterize the pathophysiology of low-renin hypertension in larger and more diverse populations. [Extracted from the article]