Table 3.

Physiologically individualized therapy^* based on renin/aldosterone profile

	Primary hyperaldosteronism	Liddle’s syndrome and variants (renal Na+ channel mutations)	Renal/renovascular
Renin	Low**	Low	High
Aldosterone	High**	Low	High
Primary treatment	Aldosterone antagonist	Amiloride	Angiotensin receptor blocker ***
	(spironolactone or eplerenone)
	Amiloride for men where		(rarely revascularization)
	eplerenone is not available
	(rarely surgery)

(Reproduced by permission of Oxford University Press from: Akintunde A, Nondi J, Gogo K, Jones ESW, Rayner BL, Hackam DG, et al. Physiological Phenotyping for Personalized Therapy of Uncontrolled Hypertension in Africa. Am J Hypertens 2017; 30: 923-30.)

^*It should be stressed that this approach is suitable for tailoring medical therapy in patients with resistant hypertension; further investigation would be required to justify adrenalectomy or renal revascularization.

^**Levels of plasma renin and aldosterone must be interpreted in the light of the medication the patient is taking at the time of sampling. In a patient taking an angiotensin receptor blocker (which would elevate renin and lower aldosterone), a plasma renin that is in the low normal range for that laboratory, with a plasma aldosterone in the high normal range, probably represents primary hyperaldosteronism for the purposes of adjusting medical therapy.

^***Angiotensin Converting Enzyme (ACE) inhibitors are less effective because of aldosterone escape via non-ACE pathways such as chymase and cathepsin; renin inhibitors are seldom used.