Drug Effects on Aldosterone/Plasma Renin Activity Ratio in Primary Aldosteronism

Abstract

Abstract-Primary aldosteronism is a specifically treatable and potentially curable form of secondary hypertension. The aldosterone/plasma renin activity ratio (ARR) is routinely used as a screening test. Antihypertensive therapy can interfere with the interpretation of this parameter, but a correct washout period can be potentially harmful. We have investigated the effects of therapy with atenolol, amlodipine, doxazosin, fosinopril, and irbesartan on the ARR in a group of 230 patients with suspected primary aldosteronism. The percent change from control of ARR in patients taking amlodipine was Ϫ17%Ϯ32; atenolol, 62%Ϯ82; doxazosin, Ϫ5%Ϯ26; fosinopril, Ϫ30%Ϯ24; and irbesartan, Ϫ43%Ϯ27. The ARR change induced by atenolol was significantly higher compared with that induced by all other drugs (PϽ0.0001), and the ARR change induced by irbesartan was significantly lower than that induced by doxazosin (PϽ0.0001). One of 55 patients from the group taking amlodipine (1.8%) and 4/17 of the patients taking irbesartan (23.5%) gave a false-negative ARR (Ͻ50). None of the patients of the groups taking fosinopril, doxazosin, and atenolol displayed a false-negative ARR. Doxazosin and fosinopril can be used in hypertensive patients who need to undergo aldosterone and PRA measurement for the diagnosis of primary aldosteronism; amlodipine gave a very small percentage of false-negative diagnoses. ␤-Blockers also do not interfere with the diagnosis of primary aldosteronism, but they can be responsible for an increased rate of false-positive ARRs. The high rate of false-negative diagnoses in patients undergoing irbesartan treatment requires confirmation in a higher number of patients.

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

“…11,13,34,35 The results of this study match well with the data of previously published studies showing that treatment with ACEI or ARB was associated with higher renin concentrations and a lower ARR. 9,17,36 Of note, the effects were more profound in patients with EH. Accordingly, the SUSPPUP ratio was less influenced by treatment with ACEI or ARB in PA.…”

Plasma Renin Activity and Aldosterone Concentrations in Hypertensive Cats with and without Azotemia and in Response to Treatment with Amlodipine Besylate

“…Previous studies in human patients receiving nifedipine and amlodipine have demonstrated a significant increase in PRA most likely because of decreased BP and sympathetic stimulation, but effects on PAC have been conflicting 40, 41, 42, 43. The response of PRA and hence ARR to amlodipine treatment in cats appears appropriate and comparable to that in humans.…”

Renal Damage in Primary Aldosteronism

“…With the exception of BP values, there were no significant differences of any variables, including UAE rate and hormone values, across treatment groups in either the PA or the PH patients, thus excluding a systematic effect of these treatments on the outcome variables. 30,31 Likewise, there were no differences in UAE rate, PRA, aldosterone, and cortisol across centers, thus making unlikely a center effect on results of these measurements.…”