*Review* **The Low-Renin Hypertension Phenotype: Genetics and the Role of the Mineralocorticoid Receptor**

**Rene Baudrand <sup>1</sup> and Anand Vaidya 2,\***


Received: 19 January 2018; Accepted: 8 February 2018; Published: 11 February 2018

**Abstract:** A substantial proportion of patients with hypertension have a low or suppressed renin. This phenotype of low-renin hypertension (LRH) may be the manifestation of inherited genetic syndromes, acquired somatic mutations, or environmental exposures. Activation of the mineralocorticoid receptor is a common final mechanism for the development of LRH. Classically, the individual causes of LRH have been considered to be rare diseases; however, recent advances suggest that there are milder and "non-classical" variants of many LRH-inducing conditions. In this regard, our understanding of the underlying genetics and mechanisms accounting for LRH, and therefore, potentially the pathogenesis of a large subset of essential hypertension, is evolving. This review will discuss the potential causes of LRH, with a focus on implicated genetic mechanisms, the expanding recognition of non-classical variants of conditions that induce LRH, and the role of the mineralocorticoid receptor in determining this phenotype.

**Keywords:** renin; low-renin; hypertension; mineralocorticoid receptor; genetics; aldosterone
