β‐Blocker withdrawal is preferable for accurate interpretation of the aldosterone–renin ratio in chronically treated hypertension

Abstract

Raised ARR consequent to β-blocker therapy causes false-positive screening for PA. Where β-blockers can be safely withdrawn, this effect is reversed within 2-3 weeks depending on whether DRC or PRA is used to calculate ARR.

11C‐Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice

“…Aldosterone at 24 hours postoperatively was undetectable and the patient has controlled hypertension on fewer agents without hypokalaemia. Subsequent follow‐up ARR was performed while the patient was taking a beta‐blocker for left ventricular hypertrophy (LVH) that may have affected renin (Table ) . For case 15, AVS was also consistent with bilateral disease, showing a LI 1.4 in favour of the left, without contralateral aldosterone suppression.…”

A cross-sectional study of the effects of β-blocker therapy on the interpretation of the aldosterone/renin ratio

“…A reduction in dose alone may not be sufficient to generate a true result. We have previously shown that b-blocker withdrawal produced a rapid recovery in PRA and DRC within 2 weeks of withdrawal and a return of the ARR to normal range in all individuals who had screened positive for primary aldosteronism [40]. Where clinically possible we advocate the complete withdrawal of b-blocker therapy before ARR is measured; at least 2 weeks prior to sampling.…”

“…Recently, we have shown that in approximately one-third of patients taking multiple antihypertensive agents that included b-blocker therapy, the ARR was screen positive. Moreover, in these patients where it was deemed medically well tolerated to withdraw b-blocker therapy, the ARR returned to normal within a period of 2-3 weeks depending on the methodology used to measure renin [40]. The aim of this study was to investigate whether or not the effect of b-blockade on the ARR could be predicted from the dosing regime in a cohort of patients with type 2 diabetes mellitus undergoing antihypertensive treatment that included b-blocker therapy.…”

The aldosterone to renin ratio in the diagnosis of primary aldosteronism: Promises and challenges

“…β‐blocker therapy suppresses renin production by inhibiting β1‐adrenergic receptors in the juxtaglomerular apparatus of the kidney . Their secondary effect to suppress aldosterone is discordant with that of renin, hence the potential to cause false‐positive interpretation of the ARR . Mulatero, et al demonstrated a statistically significant decrease of PRA and PAC and an increase in ARR ( P < 0001 for all parameters) in a cohort of hypertensive patients treated with the β‐blocker atenolol (dose of 100 mg/day) alone .…”

“…The assay used to measure renin has been suggested as a contributor to the effect of β‐blockers on the ARR. Browne et al have shown that the ARR returned to normal following β‐blocker withdrawal within 1‐2 weeks when measured using DRC and within 3‐6 weeks when measured using PRA …”