The spectrum of plasma renin activity and hypertension diseases: Utility, outlook, and suggestions

BACKGROUND: Plasma renin activity (PRA) is one of the recommended screening indicators for primary aldosteronism (PA) diagnosis and had become increasingly important in hypertension identification, medication guidance, and endocrine disorder confirmation. METHODS: To provide an overview of the PRA measurement progress and clinical value, this review summarizes the main contributing factors related to PRA measurement and necessary precautions during the entire analysis process. We also outline the characteristics of PRA in different endocrine diseases and their clinical utility. RESULTS: Significant inconsistency was observed in PRA measurement methods, including immunoassay and isotope dilution liquid chromatography–tandem mass spectrometry (ID‐LC/MS/MS), which could be attributed to preanalytical, analytical, and postanalytical variations. Meanwhile, consensus about environmental and procedural factors during the entire analytical process, including storage temperature, incubation condition, blank subtraction, and standardized operational procedures across different self‐developed assay laboratories, could be important to minimize analytical variations. Furthermore, commutable uniform calibrators should be prepared to improve consistency, ultimately achieving accurate and reliable measurement of PRA. CONCLUSION: This review summarizes the clinical utilization of PRA as a biomarker in multiple diseases, elaborating on routine detection methods and the key factors in the analytical process. We also provide feasible strategies for improving standardization and facilitating PRA assessment for larger‐scale clinical applications.