Figure 5.

Targeting renin levels during mineralocorticoid receptor antagonist therapy. The primary objectives of MR antagonist therapy include normalization of blood pressure and potassium. Once these objectives are achieved, a rise in renin is a biomarker that is associated with lower risk for adverse cardiovascular outcomes. An unsuppressed renin activity, 1.0–2.0 ng/ml/h, is an ideal range to target; however, it is likely that any increase in renin from its baseline suppressed state is indicative of beneficial MR blockade. Excessive uptitration of MR antagonists associated with much higher renin levels may herald increased risk for hyperkalemia and/or relative hypovolemia and renal hypoperfusion. Abbreviation: MR, mineralocorticoid receptor.