Renin Unsuppression

Observational studies associate renin unsuppression during MRA therapy with better long-term cardiovascular and kidney outcomes. RETAME-PA defines renin unsuppression using assay-specific thresholds because Canadian laboratories use both PRA and DRC assays without a reliable conversion between them. It remains uncertain whether unsuppressed renin causes better outcomes or merely marks milder or more MRA-sensitive disease. A retrospective cohort that titrated MRA to a PRA target greater than 1 ng/mL/hour achieved renin unsuppression in 82.1% of primary aldosteronism cases. Renin unsuppression is presented as a direct physiological indicator that aldosterone blockade and reversal of volume excess have been achieved.