Update in the clinical management of low renin hypertension

Stefano Macchiavello; Carlos Fardella; René Baudrand

Keywords: hypertension, aldosterone, spironolactone, renin, Receptors, Mineralocorticoids

Abstract

The renin-angiotensin-aldosterone system modulates volume, sodium and potassium homeostasis. In the setting of a high sodium diet, up to 30% of patients with hypertension have a low or suppressed renin and increased volume. This phenotype of low renin hypertension (LRH) is multifactorial and includes infrequent inherited genetic syndromes, milder phenotypes of classic diseases and environmental exposures. All these conditions have in common a higher cardiovascular risk mediated by the over activation of the mineralo corticoid receptor (MR), present not only in the kidney, but also in vasculature, myocardium and adipocytes. Consequently, the aim of LRH treatment goes beyond the control of blood pressure and requires antagonizing MR with specific pharmacologic agents, pursuing normalization of renin as a clinical objective. Due to the unusual evaluation of renin status by non-endocrinologists and lack of disease awareness, only a minority of hypertensive patients receive this pathophysiologically-driven treatment that should reduce cardiovascular outcomes.

Más información

Título según WOS: Update in the clinical management of low renin hypertension
Título según SCOPUS: Update in the clinical management of low renin hypertension [Actualización en el manejo clínico de la hipertensión hiporreninémica]
Título según SCIELO: Actualización en el manejo clínico de la hipertensión hiporreninémica
Título de la Revista: REVISTA MEDICA DE CHILE
Volumen: 147
Número: 4
Editorial: SOC MEDICA SANTIAGO
Fecha de publicación: 2019
Página de inicio: 490
Página final: 498
Idioma: Spanish
DOI:

10.4067/S0034-98872019000400490

Notas: ISI, SCIELO, SCOPUS