Screening for primary aldosteronism without discontinuing hypertensive medications: Plasma aldosterone-renin ratio

Gallay, Brian J.; Ahmad, Suhail; Xu, Lei; Toivola, Bert; Davidson, Robert C.

doi:10.1016/s0272-6386(01)80117-7

Cited by 270 publications

(154 citation statements)

References 16 publications

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“…Several studies concluded that mean A PL and PRA values are not significantly influenced by medication in patients with PA. 17 Other data suggest that A PL /PRA ratio or ARR (using plasma renin concentration) are valid screening tools for PA in outpatients with ongoing antihypertensive treatment. 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.…”

Section: Discussionsupporting

confidence: 90%

“…1,24,26 If the A PL /PRA ratio is used as a screening tool, the prevalence of PA in hypertensive patients varies between 9 and 13%, depending on the patient population. 2,3,6,13,27,28 However, there is still a lack of consensus regarding the appropriate method for determination of renin. PRA is dependent on the angiotensinogen concentration, as well as on renin concentration.…”

Section: Discussionmentioning

confidence: 99%

“…[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. 1 Overall, the predictive value of the ARR is hampered, as aldosterone is also regulated by factors other than angiotensin II and normal values of A PL can be amplified by very low PRA levels, leading to a high A PL /PRA ratio.…”

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: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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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“…The prevalence of PA in this study was significantly lower than that demonstrated in other worldwide studies reported in the past twenty years (7,(14)(15)(16)(17)(18)(19)(20). This may be attributable to several factors.…”

Section: Discussioncontrasting

confidence: 81%

“…Since the validation of the aldosterone: renin ratio (ARR) as a reliable method for identifying PA, several global studies have reported PA prevalence rates ranging from 3-22% (7-14) with even higher rates reported (13-33%) in certain sub-populations, such as those with resistant hypertension and hypertension associated with diabetes or obstructive sleep apnea (15)(16)(17)(18)(19)(20). These findings may justify broader criteria for screening for PA.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Primary Aldosteronism in an Urban Hypertensive Population

Galati¹,

Cheesman²,

Springer-Miller³

et al. 2016

Endocrine Practice

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Abstract:Objective: To determine the prevalence of Primary Aldosteronism (PA) in hypertensive patients presenting to the primary care clinic at The Mount Sinai Hospital, regardless of the degree of hypertension and to identify clinical criteria that should prompt screening for PA.Methods: An ARR (cutoff ≥20, with PAC ≥ 10 and suppressed renin) was used to prospectively screen 296 hypertensive patients (BP ≥ 140/90) over the age of 18 from August 2012 through May 2013.Subjects who screened positive then underwent confirmatory oral salt load testing (OSLT).Results: Of the 296 patients, fourteen screened positive for PA, an overall prevalence of 4.7%. Six of the fourteen cases underwent confirmatory OSLT upon which two confirmed positive, prevalence of 0.7%.Overall, patients with confirmed PA were more likely to have resistant hypertension (42.9% vs. 18.1% (p= 0.0334)) and require more anti-hypertensive agents (2.8 ±1.2 agents vs 2.1 ± 1.1 agents (p=0.0213)).There was a trend toward lower potassium values in the cases.Conclusion: The prevalence of PA in our clinic is much lower than in reports from certain "at-risk" populations. PA screening is indicated in patients with resistant hypertension, regardless of serum potassium levels. Introduction:

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Characterization of Resistant Hypertension<subtitle>Association Between Resistant Hypertension, Aldosterone, and Persistent Intravascular Volume Expansion</subtitle>

Nishizaka²,

et al. 2008

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Background: Resistant hypertension is a common clinical problem and greatly increases the risk of target organ damage. Methods: We evaluated the characteristics of 279 consecutive patients with resistant hypertension (uncontrolled despite the use of 3 antihypertensive agents) and 53 control subjects (with normotension or hypertension controlled by using Յ2 antihypertensive medications). Participants were prospectively examined for plasma aldosterone concentration, plasma renin activity, aldosterone to renin ratio, brain-type natriuretic peptide, atrial natriuretic peptide, and 24-hour urinary aldosterone (UAldo), cortisol, sodium, and potassium values while adhering to a routine diet. Results: Plasma aldosterone (P Ͻ.001), aldosterone to renin ratio (P Ͻ .001), 24-hour UAldo (P = .02), braintype natriuretic peptide (P = .007), and atrial natriuretic peptide (P=.001) values were higher and plasma renin activity (P=.02) and serum potassium (P Ͻ.001) values were lower in patients with resistant hypertension vs controls. Of patients with resistant hypertension, men had

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Screening for primary aldosteronism without discontinuing hypertensive medications: Plasma aldosterone-renin ratio

Cited by 270 publications

References 16 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 in an Urban Hypertensive Population

Characterization of Resistant Hypertension<subtitle>Association Between Resistant Hypertension, Aldosterone, and Persistent Intravascular Volume Expansion</subtitle>

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