Towards Better Control of Hypertension: The value of a physiological approach guided by the renin-angiotensin-aldosterone axis

Mayra A. Estacio, Facultad de Medicina, Programa de Nefrología, Universidad de Antioquia, Medellín, Colombia
Alberto Reino, Nefrón SAS, Medellin; Nephrohealth KA, Medellin; Colombia
Paula A. Fonseca, Facultad de Medicina, Programa de Nefrología, Universidad Pontificia Bolivariana, Medellín, Colombia
Juan D. López-Ponce de León, Departamento de Cardiología, Fundación Valle del Lili, Cali; Facultad de Ciencias de la Salud, Universidad Icesi, Cal;. Colombia

Introduction: To propose a pathophysiological and personalized approach for the management of resistant hypertension, based on renin and aldosterone measurements, allowing classification of hormonal phenotypes and guiding antihypertensive therapy. Material and methods: A scoping review was conducted following the PRISMA-ScR guidelines, focusing on the hormonal classification of hypertension into four main phenotypes: primary hyperaldosteronism, low-renin hypertension, renovascular activation, and Liddle-like phenotype. Their pathophysiology, biochemical profile, and therapeutic response were analyzed, with emphasis on applicability in Latin American settings. Results: Each phenotype is associated with specific therapeutic strategies (mineralocorticoid receptor antagonists, renin-angiotensin system inhibitors, amiloride, or sodium restriction). Phenotypic identification improves blood pressure control, reduces polypharmacy, and guides the search for treatable secondary causes. Conclusion: Hormonal stratification based on renin and aldosterone is a practical and accessible tool to advance personalized medicine in resistant hypertension, particularly useful in regions with a high prevalence of low-renin phenotypes. Its implementation should be integrated into a comprehensive evaluation that considers other hormonal causes of hypertension.

Keywords: Hypertension. Renin. Aldosterone. Hormonal phenotypes. Personalized medicine.