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August 15, 1977

Renin ProfilesThe Unfulfilled Promises

JAMA. 1977;238(7):611-613. doi:10.1001/jama.1977.03280070051023

ALL hypertension cannot be neatly divided into three renin levels—low, normal, and high—but the observant clinician cannot help but be impressed with the charm and simplicity offered by renin profiling.1,2 The profile is attractive because it brings some order to the unstructured mosaic of essential hypertension. Unfortunately, the etiologic, prognostic, and therapeutic implications of renin profiling have not held up under scrutiny. The "volume-vasoconstriction" model for the maintenance of hypertension does not conform to actual hemodynamic measurements made in patients.3 The prognostic promises of low renin levels have not been fulfilled,4 and the choosing of therapy based on renin status does not appear to work.5

Renin profiling, nonetheless, has a place in clinical hypertension, though a much more limited one than its proponents advocate. This review will consider briefly the problems with the promises made for renin profiling and then offer guidelines for the practitioner in