Evidence for a subgroup of essential hypertensives with non-suppressible excretion of aldosterone during sodium loading

Helber, A; Wambach, G.; Hummerich, W.; Bönner, Gerd; Meurer, K. A.; Kaufmann, W.

doi:10.1007/bf01476798

Cited by 44 publications

(14 citation statements)

References 29 publications

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“…In contrast, a raised ARR in our centre predicted primary aldosteronism in 94% of subjects [ 3]. The finding of hypertensive subjects with low renin and nonsuppressible serum aldosterone is not new, and was described about 20 years ago [ 16]. In our hands this test appears reasonably specific for primary aldosteronism if a ratio ≥750 is used.…”

Section: Discussionmentioning

confidence: 68%

Raised aldosterone to renin ratio predicts antihypertensive efficacy of spironolactone: a prospective cohort follow‐up study

Lim

Jung

MacDonald

1999

Brit J Clinical Pharma

134

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Spironolactone was a highly effective antihypertensive agent in hypertensive patients who had a raised aldosterone/renin ratio. As a raised ratio was highly predictive of nonsuppression of plasma aldosterone suggesting primary aldosteronism, it might be worthwhile using spironolactone in this subgroup of hypertensive patients with raised aldosterone/renin ratios, provided that adrenal adenomas are excluded with imaging techniques.

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Section: Discussionmentioning

confidence: 68%

Raised aldosterone to renin ratio predicts antihypertensive efficacy of spironolactone: a prospective cohort follow‐up study

Lim

Jung

MacDonald

1999

Brit J Clinical Pharma

134

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“…23,24 Hypertensive patients with 'low renin' and non-suppressible aldosterone production have been described more than 3 decades previously, who would have been diagnosed as having PA with our present criteria. [25][26][27][28] We believe that the key issue here is the response to treatment with a specific aldosterone antagonist, ie, spironolactone. We have follow-up data of up to 3 years to suggest that about 50% of these patients responded to low dose spironolactone (25-50 mg) monotherapy to achieve blood pressure control, and the need for other adjunctive antihypertensive agents was significantly reduced following the introduction of spironolactone.…”

Section: Discussionmentioning

confidence: 99%

High prevalence of primary aldosteronism in the Tayside hypertension clinic population

et al. 2000

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Primary aldosteronism (PA) was thought to be rare but recent evidence from Australia suggests that it may be more common. As this has important implications in terms of hypertension management, we undertook to screen for this treatable condition in our hypertension clinic. We obtained blood samples in sequential patients referred for assessment in our hypertension clinic in Tayside for plasma renin activity (PRA) and aldosterone. The aldosterone to PRA ratio (ARR) was used as an initial screening test to identify potential patients with PA. Those patients with an elevated ratio (у750) were admitted for the salt loading and fludrocortisone suppression test. These patients also underwent adrenal CT scanning, and in selected patients, adrenal scintigraphy. Between May 1995 and January 1997 (21 months), we screened a total of 495 patients. ARR was available in 465 (93.9%) patients. Out of that number, 77 (16.6%)

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“…Suppression of aldosterone excretion in the urine by a high salt intake was found to be abnormal in many patients with hypertension, both in those with normal or with low renin hypertension [56, 57]. Patients with essential hypertension could be divided into those who suppressed urinary aldosterone normally, for example, to <6μg/24 h, and those who could not, but the latter were not deemed to have PA unless their salt-suppressed aldosterone secretion was >12μg/24h [56].…”

Section: Are Functional Tests Useful For Discriminating Between Pa Sumentioning

confidence: 99%

“…Patients with essential hypertension could be divided into those who suppressed urinary aldosterone normally, for example, to <6μg/24 h, and those who could not, but the latter were not deemed to have PA unless their salt-suppressed aldosterone secretion was >12μg/24h [56]. Patients with abnormal suppression of urinary aldosterone to salt loading were found to exhibit similar BP elevations as those with normal suppression of urinary aldosterone to salt loading, but showed increased plasma aldosterone responsiveness to the infusion of angiotensin II [58].…”

Section: Are Functional Tests Useful For Discriminating Between Pa Sumentioning

confidence: 99%

Progress in Primary Aldosteronism: Present Challenges and Perspectives

Gómez-Sánchez

Rossi²,

Fallo³

et al. 2010

Horm Metab Res

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Primary Aldosteronism (PA) is a disorder of the adrenal zona glomerulosa (ZG) in which aldosterone secretion is increased and is relatively autonomous of normal regulatory mechanisms. A recent conference in Munich organized by Prof. Reincke addressed advances and challenges related to the screening, diagnosis, and identification of uni- and bilateral involvement of the diseased adrenal of PA. Some infrequently addressed issues are described herein. We postulate that most cases of PA are due to the activation by unknown mechanisms of subset of cells resulting in the formation of a multiple foci or nodules of hyperactive zona glomerulosa cells. This implies that one or several yet unidentified stimuli can drive aldosterone overproduction, as well as the proliferation of aldosterone-producing cells. Current diagnostic procedures allow to determine whether inappropriate aldosterone production is driven by one or both adrenal glands and thus to establish optimal treatment.

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Evidence for a subgroup of essential hypertensives with non-suppressible excretion of aldosterone during sodium loading

Cited by 44 publications

References 29 publications

Raised aldosterone to renin ratio predicts antihypertensive efficacy of spironolactone: a prospective cohort follow‐up study

Raised aldosterone to renin ratio predicts antihypertensive efficacy of spironolactone: a prospective cohort follow‐up study

High prevalence of primary aldosteronism in the Tayside hypertension clinic population

Progress in Primary Aldosteronism: Present Challenges and Perspectives

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