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Driving hypertension: non-classic apparent mineralocorticoid excess

Non-classic apparent mineralocorticoid excess is an underrecognized cause of low-renin hypertension, which is often misdiagnosed as essential hypertension. This condition challenges traditional classifications and highlights the need for mechanism-based diagnostics and medical care.

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References

  1. Shah, S. S., Fuller, P. J., Young, M. J. & Yang, J. Update on low-renin hypertension: current understanding and future direction. Hypertension 81, 2038–2048 (2024).

    Article  CAS  PubMed  Google Scholar 

  2. Shah, S. S. et al. Prevalence and characteristics of low-renin hypertension in a primary care population. J. Endocr. Soc. 8, bvae113 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Baudrand, R. & Vaidya, A. The low-renin hypertension phenotype: genetics and the role of the mineralocorticoid receptor. Int. J. Mol. Sci. 19, 546 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Carvajal, C. A., Tapia-Castillo, A., Vecchiola, A., Baudrand, R. & Fardella, C. E. Classic and nonclassic apparent mineralocorticoid excess syndrome. J. Clin. Endocrinol. Metab. 105, dgz315 (2020).

    Article  PubMed  Google Scholar 

  5. Tapia-Castillo, A. et al. Clinical, biochemical and genetic characteristics of “non-classical” apparent mineralocorticoid excess syndrome. J. Clin. Endocrinol. Metab. 104, 595–603 (2019).

    Article  PubMed  Google Scholar 

  6. Yau, M. et al. Clinical, genetic, and structural basis of apparent mineralocorticoid excess due to 11beta-hydroxysteroid dehydrogenase type 2 deficiency. Proc. Natl Acad. Sci. USA 114, E11248–E11256 (2017).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Carvajal, C. A. et al. Serum cortisol and cortisone as potential biomarkers of partial 11beta-hydroxysteroid dehydrogenase type-2 deficiency. Am. J. Hypertens. 31, 910–918 (2018).

    Article  CAS  PubMed  Google Scholar 

  8. Carvajal, C. A., Tapia-Castillo, A., Uslar, T. & Fardella, C. E. in Hydro Saline Metabolism: Epidemiology, Genetics, Pathophysiology, Diagnosis and Treatment (eds M. Caprio & F. L. Fernandes-Rosa) 31–349 (Springer International Publishing, 2023).

  9. Adler, G. K. et al. Primary aldosteronism: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 110, 2453–2495 (2025).

    Article  CAS  PubMed  Google Scholar 

  10. Shah, S. S. et al. Efficacy and safety of mineralocorticoid receptor antagonists for the treatment of low-renin hypertension: a systematic review and meta-analysis. J. Hum. Hypertens. 38, 383–392 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors acknowledge the support of grants ANID-FONDECYT 1212006 (C.A.C.), ICM-ANID ICN2021_045 (C.A.C., C.E.F.), 11251675 (A.T.-C.), ANILLO ACT 210039 (R.B.), SOCHED 2024-06 (A.T.-C.) and CETREN-UC 2024 (C.A.C., C.E.F.).

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Correspondence to Cristian A. Carvajal or Carlos E. Fardella.

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Carvajal, C.A., Tapia-Castillo, A., Uslar, T. et al. Driving hypertension: non-classic apparent mineralocorticoid excess. Nat Rev Endocrinol (2025). https://doi.org/10.1038/s41574-025-01209-6

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