{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:03:21Z","timestamp":1785816201059,"version":"3.56.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000925","name":"Department of Health | National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP1194576"],"award-info":[{"award-number":["APP1194576"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"Department of Health | National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP2013946"],"award-info":[{"award-number":["APP2013946"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"Department of Health | National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP2013946"],"award-info":[{"award-number":["APP2013946"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004430","name":"Baker IDI Heart and Diabetes Institute","doi-asserted-by":"publisher","award":["DP230103229"],"award-info":[{"award-number":["DP230103229"]}],"id":[{"id":"10.13039\/501100004430","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004430","name":"Baker IDI Heart and Diabetes Institute","doi-asserted-by":"publisher","award":["DP230103229"],"award-info":[{"award-number":["DP230103229"]}],"id":[{"id":"10.13039\/501100004430","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Victorian Government\u2019s Operational Infrastructure Scheme"},{"name":"Victoria Government&apos;s Operational Infrastructure Scheme"},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","award":["106729"],"award-info":[{"award-number":["106729"]}],"id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Hum Hypertens"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Emerging evidence suggests that patients with low-renin hypertension (LRH) benefit from targeted treatment with mineralocorticoid receptor antagonists (MRA). With broader screening for primary aldosteronism (PA), clinicians are increasingly identifying patients with low renin levels who do not meet current diagnostic criteria for PA. In the absence of specific management guidelines, these patients are often treated as having primary hypertension. This study aimed to assess the prevalence, clinical characteristics, and real-world management of LRH in a tertiary endocrine hypertension clinic. We conducted a retrospective audit of patients evaluated between 2016 and 2021. PA was diagnosed based on saline suppression test (SST) results. LRH and normal renin hypertension (NRH) were classified using a direct renin concentration below or above 10mU\/L, respectively. Among 409 eligible patients, 82 (20%) had LRH, 221 (54%) had PA, and 106 (26%) had NRH. Compared to NRH, patients with LRH were older despite a similar duration of hypertension, more likely to be female, and non-Caucasian. They also had a lower 24-h urinary aldosterone excretion compared to both PA and NRH. Automated office blood pressure, urinary sodium, and potassium excretion were similar across groups. Only 25 patients with LRH (31%) were prescribed an MRA; others were prescribed conventional antihypertensive agents and\/or discharged to their primary care physician. LRH was present in one-fifth of patients referred to for endocrine hypertension assessment. Management was inconsistent, underscoring the need for evidence-based diagnostic and treatment strategies for this under-recognized subtype of hypertension.<\/jats:p>","DOI":"10.1038\/s41371-026-01148-3","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T15:27:40Z","timestamp":1778599660000},"page":"541-547","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence, clinical characteristics and management of low-renin hypertension: a real-world cohort study"],"prefix":"10.1038","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5789-383X","authenticated-orcid":false,"given":"Sonali S.","family":"Shah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chrislyn","family":"Ng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minn Wei","family":"Chow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0948-2072","authenticated-orcid":false,"given":"Peter J.","family":"Fuller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0450-5375","authenticated-orcid":false,"given":"Morag J.","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Libianto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4620-4976","authenticated-orcid":false,"given":"Jun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"1148_CR1","doi-asserted-by":"publisher","first-page":"2826","DOI":"10.1210\/jc.2016-1472","volume":"101","author":"SC Kayser","year":"2016","unstructured":"Kayser SC, Dekkers T, Groenewoud HJ, van der Wilt GJ, Carel Bakx J, van der Wel MC, et al. Study heterogeneity and estimation of prevalence of primary aldosteronism: a systematic review and meta-regression analysis. J Clin Endocrinol Metab. 2016;101:2826\u201335.","journal-title":"J Clin Endocrinol Metab"},{"key":"1148_CR2","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1507\/endocrj.EJ21-0508","volume":"69","author":"M Naruse","year":"2022","unstructured":"Naruse M, Katabami T, Shibata H, Sone M, Takahashi K, Tanabe A, et al. Japan endocrine society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021. Endocr J. 2022;69:327\u201359.","journal-title":"Endocr J"},{"key":"1148_CR3","doi-asserted-by":"publisher","first-page":"3912","DOI":"10.1093\/eurheartj\/ehae178","volume":"45","author":"JW McEvoy","year":"2024","unstructured":"McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45:3912\u20134018.","journal-title":"Eur Heart J"},{"key":"1148_CR4","doi-asserted-by":"publisher","first-page":"2453","DOI":"10.1210\/clinem\/dgaf284","volume":"110","author":"GK Adler","year":"2025","unstructured":"Adler GK, Stowasser M, Correa RR, Khan N, Kline G, McGowan MJ, et al. Primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2025;110:2453\u201395.","journal-title":"J Clin Endocrinol Metab"},{"key":"1148_CR5","doi-asserted-by":"publisher","first-page":"10","DOI":"10.7326\/M20-0065","volume":"173","author":"JM Brown","year":"2020","unstructured":"Brown JM, Siddiqui M, Calhoun DA, Carey RM, Hopkins PN, Williams GH, et al. The unrecognized prevalence of primary aldosteronism: a cross-sectional study. Ann Intern Med. 2020;173:10\u201320.","journal-title":"Ann Intern Med"},{"key":"1148_CR6","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1038\/s41371-023-00891-1","volume":"38","author":"SS Shah","year":"2024","unstructured":"Shah SS, Zhang J, Gwini SM, Young MJ, Fuller PJ, Yang J. Efficacy and safety of mineralocorticoid receptor antagonists for the treatment of low-renin hypertension: a systematic review and meta-analysis. J Hum Hypertens. 2024;38:383\u201392.","journal-title":"J Hum Hypertens"},{"key":"1148_CR7","doi-asserted-by":"publisher","first-page":"dgz150","DOI":"10.1210\/clinem\/dgz150","volume":"105","author":"M Thuzar","year":"2020","unstructured":"Thuzar M, Young K, Ahmed AH, Ward G, Wolley M, Guo Z, et al. Diagnosis of primary aldosteronism by seated saline suppression test-variability between immunoassay and HPLC-MS\/MS. J Clin Endocrinol Metab. 2020;105:dgz150.","journal-title":"J Clin Endocrinol Metab"},{"key":"1148_CR8","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1038\/s41371-024-00931-4","volume":"38","author":"SS Shah","year":"2024","unstructured":"Shah SS, Gwini SM, Stowasser M, Reid CM, Young MJ, Fuller PJ, et al. A Randomized trial assessing efficacy and safety of mineralocorticoid receptor antagonist therapy compared to standard antihypertensive therapy in hypErtension with low renin (REMASTER): rationale and study design. J Hum Hypertens. 2024;38:663\u20138.","journal-title":"J Hum Hypertens"},{"key":"1148_CR9","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1093\/ndt\/gfs587","volume":"28","author":"Y Ori","year":"2013","unstructured":"Ori Y, Chagnac A, Korzets A, Zingerman B, Herman-Edelstein M, Bergman M, et al. Regression of left ventricular hypertrophy in patients with primary aldosteronism\/low-renin hypertension on low-dose spironolactone. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association. 2013;28:1787\u201393.","journal-title":"Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association"},{"key":"1148_CR10","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1016\/S2213-8587(18)30071-8","volume":"6","author":"B Williams","year":"2018","unstructured":"Williams B, MacDonald TM, Morant SV, Webb DJ, Sever P, McInnes GT, et al. Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies. Lancet Diabetes Endocrinol. 2018;6:464\u201375.","journal-title":"Lancet Diabetes Endocrinol"},{"key":"1148_CR11","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1093\/ajh\/hpad032","volume":"36","author":"A Mansur","year":"2023","unstructured":"Mansur A, Vaidya A, Turchin A. Using renin activity to guide mineralocorticoid receptor antagonist therapy in patients with low renin and hypertension. Am J Hypertens. 2023;36:455\u201361.","journal-title":"Am J Hypertens"},{"key":"1148_CR12","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1161\/HYPERTENSIONAHA.125.24711","volume":"82","author":"CH Tsai","year":"2025","unstructured":"Tsai CH, Brown JM, Parisien-La Salle S, Newman AJ, Wu VC, Lin YH, et al. ACE inhibition to distinguish low-renin hypertension from primary aldosteronism. Hypertension. 2025;82:1046\u201355.","journal-title":"Hypertension"},{"key":"1148_CR13","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1038\/s41371-019-0291-y","volume":"34","author":"Q Luo","year":"2020","unstructured":"Luo Q, Li N, Wang M, Yao X, Heizhati M, Zhang D, et al. Mild primary aldosteronism (PA) followed by overt PA are possibly the most common forms of low renin hypertension: a single-center retrospective study. J Hum Hypertens. 2020;34:633\u201340.","journal-title":"J Hum Hypertens"},{"key":"1148_CR14","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1177\/1470320310391922","volume":"12","author":"A Vaidya","year":"2011","unstructured":"Vaidya A, Forman JP, Hopkins PN, Seely EW, Williams JS. 25-Hydroxyvitamin D is associated with plasma renin activity and the pressor response to dietary sodium intake in caucasians. J Renin Angiotensin Aldosterone Syst. 2011;12:311\u20139.","journal-title":"J Renin Angiotensin Aldosterone Syst"},{"key":"1148_CR15","doi-asserted-by":"publisher","first-page":"bvae113","DOI":"10.1210\/jendso\/bvae113","volume":"8","author":"SS Shah","year":"2024","unstructured":"Shah SS, Libianto R, Gwini SM, Rusell G, Young MJ, Fuller PJ, et al. Prevalence and characteristics of low-renin hypertension in a primary care population. J Endocr Soc. 2024;8:bvae113.","journal-title":"J Endocr Soc"},{"key":"1148_CR16","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1093\/ajh\/hpt276","volume":"27","author":"DE Rifkin","year":"2014","unstructured":"Rifkin DE, Khaki AR, Jenny NS, McClelland RL, Budoff M, Watson K, et al. Association of renin and aldosterone with ethnicity and blood pressure: the multi-ethnic study of atherosclerosis. Am J Hypertens. 2014;27:801\u201310.","journal-title":"Am J Hypertens"},{"key":"1148_CR17","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1210\/js.2017-00134","volume":"1","author":"K Omata","year":"2017","unstructured":"Omata K, Anand SK, Hovelson DH, Liu CJ, Yamazaki Y, Nakamura Y, et al. Aldosterone-producing cell clusters frequently harbor somatic mutations and accumulate with age in normal adrenals. J Endocr Soc. 2017;1:787\u201399.","journal-title":"J Endocr Soc"},{"key":"1148_CR18","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1038\/s41569-025-01135-0","volume":"22","author":"SK Masenga","year":"2025","unstructured":"Masenga SK, Wandira N, Cattivelli-Murdoch G, Saleem M, Beasley H, Hinton A Jr., et al. Salt sensitivity of blood pressure: mechanisms and sex-specific differences. Nat Rev Cardiol. 2025;22:611\u201328.","journal-title":"Nat Rev Cardiol"},{"key":"1148_CR19","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1177\/1470320310391331","volume":"12","author":"CC Kuo","year":"2011","unstructured":"Kuo CC, Wu VC, Tsai CW, Wu KD. Taiwan primary aldosteronism investigation study G. relative kidney hyperfiltration in primary aldosteronism: a meta-analysis. J Renin Angiotensin Aldosterone Syst. 2011;12:113\u201322.","journal-title":"J Renin Angiotensin Aldosterone Syst"},{"key":"1148_CR20","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1038\/nrneph.2012.19","volume":"8","author":"I Helal","year":"2012","unstructured":"Helal I, Fick-Brosnahan GM, Reed-Gitomer B, Schrier RW. Glomerular hyperfiltration: definitions, mechanisms and clinical implications. Nat Rev Nephrol. 2012;8:293\u2013300.","journal-title":"Nat Rev Nephrol"},{"key":"1148_CR21","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/j.ahj.2004.12.005","volume":"150","author":"MH Weinberger","year":"2005","unstructured":"Weinberger MH, White WB, Ruilope LM, MacDonald TM, Davidson RC, Roniker B, et al. Effects of eplerenone versus losartan in patients with low-renin hypertension. Am Heart J. 2005;150:426\u201333.","journal-title":"Am Heart J"},{"key":"1148_CR22","doi-asserted-by":"publisher","first-page":"2745","DOI":"10.1210\/jc.2014-1153","volume":"99","author":"AH Ahmed","year":"2014","unstructured":"Ahmed AH, Cowley D, Wolley M, Gordon RD, Xu S, Taylor PJ, et al. Seated saline suppression testing for the diagnosis of primary aldosteronism: a preliminary study. J Clin Endocrinol Metab. 2014;99:2745\u201353.","journal-title":"J Clin Endocrinol Metab"},{"key":"1148_CR23","doi-asserted-by":"publisher","first-page":"408","DOI":"10.5694\/mja2.51438","volume":"216","author":"R Libianto","year":"2022","unstructured":"Libianto R, Russell GM, Stowasser M, Gwini SM, Nuttall P, Shen J, et al. Detecting primary aldosteronism in Australian primary care: a prospective study. Med J Aust. 2022;216:408\u201312.","journal-title":"Med J Aust"}],"container-title":["Journal of Human Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41371-026-01148-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41371-026-01148-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41371-026-01148-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T22:02:29Z","timestamp":1783548149000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41371-026-01148-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":23,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["1148"],"URL":"https:\/\/doi.org\/10.1038\/s41371-026-01148-3","relation":{},"ISSN":["1476-5527"],"issn-type":[{"value":"1476-5527","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,12]]},"assertion":[{"value":"24 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 March 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 May 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no conflicts of interest to declare. Data availability for datasets generated during and\/or analyzed during the current study is not publicly available but can be made available from the corresponding author upon reasonable request.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}