High Plasma Renin and Aldosterone Levels Are Associated With a Unique Phenotype in Primary Hypertension

Background and Objectives: Substantial efforts have been made to categorize the diverse and broad population of individuals with primary hypertension into more defined, homogeneous subgroups according to their hormonal responses to biological stimuli, such as low-renin hypertension. This study aimed to explore the phenotype and prognosis of patients with untreated primary hypertension with high renin and aldosterone levels. Methods: In this study, we explored hypertensive phenotypes related to renin and aldosterone levels in untreated patients with primary hypertension (n=747). Patients were stratified into 4 groups on the basis of plasma renin activity (≥1.0 ng/mL/hr or <1.0 ng/mL/hr) and the plasma aldosterone concentration (≥15 ng/dL or <15 ng/dL).: high renin and aldosterone (n=172), low renin and high aldosterone (n=70), high renin and low aldosterone (n=308), and low renin and aldosterone (n=196). Results: Multinomial logistic regression analysis revealed that younger age (p<0.001), higher pulse rates (p=0.002), and greater nighttime systolic blood pressure (p=0.046) were independent predictors of high renin and aldosterone levels. Microalbuminuria (25.5%, p<0.001) and elevated uric acid levels (5.5±1.4 mg/dL, p=0.006) were also more prevalent in this group. Conclusions: These findings highlight the importance of stratifying hypertensive phenotypes to enable personalized treatment for primary hypertensives with elevated renin and aldosterone levels.