Age‐ and sex‐specific reference ranges are needed for the aldosterone/renin ratio

Solanki, Pravik; Gwini, Stella May; Doery, James C.G.; Choy, Kay Weng; Shen, Jimmy; Young, Morag J.; Fuller, Peter J.; Yang, Jun

doi:10.1111/cen.14199

Cited by 16 publications

(18 citation statements)

References 27 publications

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“…That is, PAC displays a downward trend with increasing age, when age is ≥50 years 34 and women have higher levels of PAC than men. 35,36 Our data are consistent with previous studies. In stratified analysis by sex, a larger association between PAC and aortic dissection and aneurysm is observed among women as compared with men.…”

Section: Discussionsupporting

confidence: 93%

Higher Plasma Aldosterone Concentrations Are Associated With Elevated Risk of Aortic Dissection and Aneurysm: a Case-Control Study

et al. 2022

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Background: Animal models demonstrate circulating aldosterone leads to aortic dissection and aneurysm, whereas data from humans are lacking. Therefore, we aimed to examine the associations of plasma aldosterone concentrations (PAC) with aortic dissection and aneurysm. Methods: We identified patients with aortic dissection and aneurysm with assessed PAC before disease onset from hospital-based electronic database and set as case group. Simultaneously, age and gender-matched cohort with PAC measurement whereas without aortic dissection and aneurysm were selected as control group using ratio of 1:4. Multi-variable logistic regression analysis was used to assess the relationship of PAC with aortic dissection and aneurysm. Results: Totally, 133 cases and 531 controls (all hypertensive) were enrolled between 2004 and 2021, with 77.9% men, mean age of 55.5 years and PAC of 13.9 ng/dL. Case group showed significantly higher PAC(14.51 versus 13.65 ng/dL, P =0.012) than did control group. In logistic regression analysis, higher PAC exhibited 1.68-fold higher odds (95% CI, 1.14–2.48, P =0.008) for presence of aortic dissection and aneurysm, significant in adjusted model (odds ratio, 1.69 [95% CI, 1.11–2.57], P =0.015). In stratified analysis, the association between the 2 was observed in women of all ages and in men with coronary artery disease. Sensitivity analysis by excluding those under interfering agents at PAC measurement and those with primary aldosteronism did not change the relationship of the 2. Conclusions: Higher PAC is associated with the increased odd for aortic dissection and aneurysm in patients with hypertension, even in the absence of primary aldosteronism, implying that PAC might be a target for prevention.

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Section: Discussionsupporting

confidence: 93%

Higher Plasma Aldosterone Concentrations Are Associated With Elevated Risk of Aortic Dissection and Aneurysm: a Case-Control Study

et al. 2022

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“…While our calculated reference values for aldosterone generally showed an overlap with manufacturer's reference ranges, in the case of renin our calculated reference showed a clear upwards shift, i. e. both lower and upper cut-offs were higher than those suggested by the manufacturer. This is in accordance with observations of Solanki et al [15], who suggest that manufacturer-provided reference ranges should be used with caution and sex-specific reference ranges should be established.…”

Section: Meansupporting

confidence: 92%

“…In view of the recent data on sex differences in aldosterone and renin concentrations [15], we also decided to measure aldosterone and renin concentrations in 22 healthy non-pregnant euthyroid women.…”

Section: Methodsmentioning

confidence: 99%

“…Recent data [15] showing significant sex-related differences in aldosterone and direct renin concentrations, particularly in people of reproductive age (20-39 years) prompted us to measure aldosterone and renin also in the control group and to calculate the aldosterone-to-renin ratio for non-pregnant women of reproductive age. Although the number of non-pregnant subjects in our study was smaller (n = 22), the data are still comparable to those provided by the manufacturer, given that the reference values were determined based on a relatively small number of subjects (e. g. only 40 women aged 18-65 years, for manufacturer-calculated renin concentrations).…”

Section: Meanmentioning

confidence: 99%

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Establishing Reference Ranges for Aldosterone, Renin and Aldosterone-to-Renin Ratio for Women in the Third-Trimester of Pregnancy

Lewandowski

Tadros-Zins

Horzelski

et al. 2022

Exp Clin Endocrinol Diabetes

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Objective Diagnosis of primary hyperaldosteronism in pregnancy is complicated due to lack of reference ranges for aldosterone, renin and aldosterone-to-renin ratio. We have endeavoured to establish third-trimester reference ranges for the above-mentioned parameters. Design & Patients We performed postural tests for aldosterone and renin (chemiluminescence immunoassay Liason® DiaSorin Inc., Italy) in 70 healthy pregnant women (age 30.53±4.51 years), at 32.38±4.25 weeks of gestation and in 22 non-pregnant healthy women (age 33.08±8.72 years). Results Aldosterone reference ranges were 6.51–73.97 ng/dl and 12.33–86.38 ng/dl, for supine and upright positions, respectively and that for renin were 6.25–59.36 µIU/ml and 11.12–82.55 µIU/ml, respectively. Aldosterone and renin concentrations were higher in an upright position (p=0.000459 and p=0.00011, respectively). In contrast, aldosterone-to-renin ratio was not affected by posture (i. e. 0.497–3.084 ng/dl/µIU/ml versus 0.457–3.06 ng/dl/µIU/ml, p=0.12), but was higher (p=0.00081) than in non-pregnant controls. In comparison to manufacturer-provided non-pregnant reference range, supine aldosterone concentrations increased by 556% (lower cut-off) and 313% (upper cut-off), while upright aldosterone concentrations increased by 558% (lower cut-off) and 244% (upper cut-off). The reference range for supine renin concentrations increased by 223% (lower cut-off) and 48.7% (upper cut-off), while upright renin concentrations increased by 253% (lower cut-off) and 79% (upper cut-off). Conclusions There is an upward shift in aldosterone and renin reference ranges in the third-trimester of pregnancy accompanied by an increase in an aldosterone-to-renin ratio, that is not influenced by posture. It remains to be established whether the aldosterone-to-renin ratio may be used as a screening tool for primary hyperaldosteronism in pregnancy.

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“…Consistent with this observation, the current study found higher NLR in males. There is a higher proportion of females in our control group because the majority of patients referred to our centers have an elevated ARR at baseline and females have higher ARR than males [ 35 ]. Therefore, it is more likely to find women with “falsely” elevated ARR who subsequently tested negative on the SST and these patients contributed to the control group.…”

Section: Discussionmentioning

confidence: 99%

A multi-centre study of neutrophil-to-lymphocyte ratio in primary aldosteronism

Libianto

Chee

et al. 2020

Journal of the Endocrine Society

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Background Hypertensive patients with primary aldosteronism (PA) have a higher risk of cardiovascular complications than those with blood pressure-matched essential hypertension. The excess cardiovascular consequences of PA can be attributed to the pro-inflammatory effect of excessive aldosterone and mineralocorticoid receptor activation in a range of peripheral tissues and cell types. The neutrophil-to-lymphocyte ratio (NLR) is a widely available markers of inflammation which has been shown to predict cardiovascular outcome in the general population. This study aims to evaluate the use of NLR as a potential biomarker of PA and PA severity. Methods Patients with PA (n=355) were identified from two large PA databases in Australia and China, while controls (n=222) were patients with hypertension who were referred for assessment but did not meet the diagnostic criteria for PA. The NLR was retrospectively collected from routine full blood examination, prior to commencement of targeted treatment for PA. Results The NLR did not differ between PA patients and hypertensive controls (median 2.3 and 2.4, p=0.563). However, amongst patients with PA, the NLR was positively correlated with baseline and post-saline aldosterone levels (r=0.22 and p<0.001 for both) and negatively correlated with serum potassium (r=-0.15, p=0.006). Furthermore, in a logistic regression analysis of data from patients with PA, the NLR predicted the presence of co-morbid CKD (defined as eGFR < 60mL/min/1.73m 2) with an odds ratio of 1.5 (p=0.003). Conclusion Whilst the NLR did not distinguish PA from controls, it was a marker of PA severity, being associated with aldosterone concentration as well as the presence of CKD. A prospective study is needed to further clarify the role of NLR in predicting end-organ damage associated with PA.

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Age‐ and sex‐specific reference ranges are needed for the aldosterone/renin ratio

Cited by 16 publications

References 27 publications

Higher Plasma Aldosterone Concentrations Are Associated With Elevated Risk of Aortic Dissection and Aneurysm: a Case-Control Study

Higher Plasma Aldosterone Concentrations Are Associated With Elevated Risk of Aortic Dissection and Aneurysm: a Case-Control Study

Establishing Reference Ranges for Aldosterone, Renin and Aldosterone-to-Renin Ratio for Women in the Third-Trimester of Pregnancy

A multi-centre study of neutrophil-to-lymphocyte ratio in primary aldosteronism

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