A prospective study enrolling 184 patients with elevated ARR and negative confirmatory tests from two hypertension centers in Torino and Munich was followed up for 2-5 years, with 20% of patients with negative confirmatory tests developing significant PA (17). In these individuals with low renin levels, autonomous secretion of aldosterone increases their risk of hypertension and cardiovascular and renal disease (15, 18, 19), and these risks can be mitigated by targeted therapies such as mineralocorticoid receptor antagonists. This evidence concerns the gene REN and kidney disorder.