Influence of antihypertensive medication on aldosterone and renin concentration in the differential diagnosis of essential hypertension and primary aldosteronism

Seifarth, C.; Trenkel, Stefan; Schobel, Hans P.; Hahn, Eckart G.; Hensen, J.

doi:10.1046/j.1365-2265.2002.01613.x

Cited by 151 publications

(117 citation statements)

References 40 publications

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“…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.…”

Section: Discussionmentioning

confidence: 96%

“…However, the A PL /PRA ratio is influenced by numerous factors and sampling conditions, including age, sodium intake, time of day when the samples are collected, posture, serum potassium concentration, kidney function and medication. [9][10][11][12] Other studies indicated that A PL /PRA is a valid screening test also in patients with ongoing antihypertensive treatment. 13 As many factors affect the A PL /PRA, it was recommended as a screening test only and it should be repeated if initial results are inconclusive.…”

Section: Introductionmentioning

confidence: 99%

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Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

et al. 2010

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It is suggested to use the aldosterone-to-renin ratio (ARR) as a first test in the screening for primary aldosteronism (PA). However, many groups rather rely on the determination of urinary tetrahydroaldosterone secretion; others calculate a ratio of urinary aldosterone to plasma renin activity. The aim of the present study was to evaluate the usefulness of different parameters of aldosterone excess in the case finding of PA. The study included 28 patients with PA and 33 subjects with essential hypertension. Clinical data, which included the hormonal parameters, serum aldosterone, plasma renin concentration, urinary free aldosterone and metabolites and serum and urinary electrolyte levels were analyzed. These indices of aldosterone excess, the ARR, serum sodium to urinary sodium to (serum potassium) 2 to urinary potassium (SUSPPUP) ratio and combinations of these parameters were compared between the groups. Receiver-operating curve analysis revealed that the ARR multiplied by the SUSPPUP ratio (ARRÂSUSPPUP) is the most reliable screening test, with a sensitivity of 92.3% and a specificity of 93.9% (cutoff point 199.2 (mmol l À1 ) À1 ). The combination of ARRÂSUSPPUP ratio with urinary free aldosterone divided by the plasma renin concentration rendered a specificity of 100%. Less useful was the correction of urinary free aldosterone and its metabolites for sodium excretion. Although the ARR and urinary free aldosterone divided by renin are good tests in the screening for PA, the combination of ARR with SUSPPUP ratio is a better indicator of an aldosterone excess and aldosterone action in patients with ongoing antihypertensive medication. Antihypertensive drugs only marginally interfere with the SUSPPUP ratio, but they may influence the ARR, whereby the effects in PA patients seem to be negligible.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

et al. 2010

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“…ALD antagonists were discontinued at least 6 weeks before the investigation; angiotensin converting enzyme (ACE) inhibitors and Ang II receptor blockers were discontinued 4 weeks before; β-blockers, dihydropyridine-type calcium antagonists and clonidine were progressively reduced and withdrawn 2 weeks before. α1-Blockers and slow-release forms of verapamil, which have a lesser effect on the ARR (29,30) were withdrawn 1 week before. Medications that might interfere with the renin-ALD axis, such as steroids, sex hormones, liquorice or non-steroidal anti-inflammatory drugs were also withheld for at least 3 weeks.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of Primary Aldosteronism among Unselected Hypertensive Patients: A Prospective Study Based on the Use of an Aldosterone/Renin Ratio above 25 as a Screening Test

et al. 2007

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“…Entretanto, alguns investigadores acreditam que valores muito elevados dessa relação seriam suficientes para o diagnóstico definitivo (14). Um ponto que deve ser levado em consideração na interpretação da relação A/ARP é que vários medicamentos podem interferir na sua acurácia (15,16). Assim, beta-bloqueadores elevam a relação e a maioria dos outros agentes hipotensores (diuréticos, inibidores da ECA e de receptores de angiotensina, bloqueadores de canais de cálcio, bloqueadores de receptores alfa-adrenérgicos) a diminuem e, portanto, podem interferir na interpretação dos resultados.…”

Section: Discussionunclassified

Hiperaldosteronismo primário causado por aldosteronoma: problemas no diagnóstico etiológico

Danilovic

Freire

Paraíba

et al. 2007

Arq Bras Endocrinol Metab

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RESUMOO hiperaldosteronismo primário (HAP) representa importante causa de hipertensão arterial secundária, potencialmente curável, que tem recebido atenção recente em função do aumento de sua prevalência desde a introdução do rastreamento pelo uso da relação aldosterona/atividade plasmática de renina. Apresentamos caso de HAP causado por provável aldosteronoma, coexistente com adenoma adrenal não-funcionante contra-lateral, o que dificultou o diagnóstico etiológico. Discutimos as formas mais apropriadas de rastrear, confirmar o diagnóstico de HAP e diferenciar as suas diversas etiologias, com destaque para o papel do cateterismo de adrenais no diagnóstico diferencial definitivo entre aldosteronoma e hiperaldosteronismo idiopático, com implicações no sucesso terapêutico. Primary aldosteronism (PA) represents an important cause of secondary hypertension, potentially curable, and it has been receiving particular attention due to its increasing prevalence, after the beginning of the use of plasma aldosterone concentration to plasma renin activity ratio as a screening method. We present a case of PA caused by an aldosteronoma associated with a contralateral nonfunctioning adrenal adenoma, which resulted in difficulties in the final diagnosis. We discuss the most appropriated tests to screen, confirm the diagnosis of PA and define the etiology of the disorder, especially the adrenal veins sampling to distinguish the aldosteronoma and idiopathic hyperaldosteronism and to guide successful treatment.

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Influence of antihypertensive medication on aldosterone and renin concentration in the differential diagnosis of essential hypertension and primary aldosteronism

Cited by 151 publications

References 40 publications

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

Prevalence of Primary Aldosteronism among Unselected Hypertensive Patients: A Prospective Study Based on the Use of an Aldosterone/Renin Ratio above 25 as a Screening Test

Hiperaldosteronismo primário causado por aldosteronoma: problemas no diagnóstico etiológico

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