Key result
Low-renin hypertension affects ~32% of adults with hypertension globally, rising to ~47% in Black cohorts.
Why the study?
Clinical guidelines do not address individuals with low-renin hypertension who do not meet diagnostic criteria for primary aldosteronism, even though emerging evidence suggests they may benefit from treatment distinct from standard antihypertensive therapy.
Meta-Analysis (n=13,210)
Yes
Answers are grounded in this paper and cite their sources.
Low-renin hypertension without primary aldosteronism is highly prevalent globally (affecting ~32% of hypertensive patients and 47% in predominantly Black cohorts), highlighting a major gap in current hypertension guidelines.
BACKGROUND: Current recommendations support measuring plasma renin and aldosterone in all adults with hypertension to detect primary aldosteronism (PA). However, clinical guidelines do not address individuals with low renin (commonly defined as a direct renin concentration <10 mU/l or plasma renin activity <1 ng/ml/h) who do not meet diagnostic criteria for PA and have normal or low aldosterone concentration, a normal aldosterone-to-renin ratio, and/or adequate suppression of aldosterone following salt loading or captopril challenge. This systematic review aimed to estimate the global prevalence of low-renin hypertension, as emerging evidence suggests this group may benefit from treatment distinct from standard antihypertensive therapy. METHODS: The protocol was registered with PROSPERO (CRD42023467251). MEDLINE, Embase, and Cochrane databases were searched for studies reporting renin measurements in hypertension. Two reviewers independently screened studies and extracted data, with disagreements resolved by consensus. Study quality was assessed using the Joanna Briggs Institute tool. Pooled prevalence estimates and heterogeneity were calculated using random-intercept logistic regression and I2 statistics. RESULTS: Of 2745 records identified (1968-2024), 56 studies involving 13 210 participants met inclusion criteria. The pooled prevalence of low-renin hypertension was 32% (95% CI 28-35%; I2 = 94%). Prevalence was higher in studies with >70% Black participants (47% vs. 30%, P = 0.034). In studies with confirmatory testing to exclude PA, the pooled prevalence was 27% (95% CI 25-29%; I2 = 0%). CONCLUSION: Low-renin hypertension affects a substantial proportion of individuals with hypertension, particularly among Black populations. Further research is necessary to guide optimal management.
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Shah et al. (2026) conducted a meta-analysis in Hypertension (n=13,210). Renin measurement for low-renin hypertension was evaluated on Pooled prevalence of low-renin hypertension (Prevalence 32%, 95% CI 28-35%). Low-renin hypertension had a global pooled prevalence of 32% (95% CI 28-35%) among adults with hypertension, rising to 47% in predominantly Black cohorts.
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