Published online before print October 21, 2002, doi: 10.1161/01.HYP.0000038478.59760.41
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Hypertension. 2002;40:897.)
© 2002 American Heart Association, Inc.
Scientific Contributions |
Drug Effects on Aldosterone/Plasma Renin Activity Ratio in Primary Aldosteronism
From the Department of Medicine and Experimental Oncology, Hypertension Unit, University of Torino, Torino, Italy.
Correspondence to Dr Paolo Mulatero, Department of Medicine and Experimental Oncology, Hypertension Unit, San Vito Hospital, Strada S. Vito 34, 10133 Torino, Italy. E-mail paolo.mulatero{at}libero.it
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 -17%±32; atenolol, 62%±82; doxazosin, -5%±26; fosinopril, -30%±24; and irbesartan, -43%±27. The ARR change induced by atenolol was significantly higher compared with that induced by all other drugs (P<0.0001), and the ARR change induced by irbesartan was significantly lower than that induced by doxazosin (P<0.0001). 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 (<50). 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. ß-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.
Key Words: aldosterone • renin • antihypertensive therapy • plasma
This article has been cited by other articles:
 |
|
 |
|
  B Rayner Primary aldosteronism and aldosterone-associated hypertension J. Clin. Pathol., July 1, 2008; 61(7): 825 - 831. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Quack, O. Vonend, L. Sellin, J. Stegbauer, G. Dekomien, and L. C. Rump A Tale of Two Patients With Mendelian Hypertension Hypertension, March 1, 2008; 51(3): 609 - 614. [Full Text] [PDF]
|
|
|
|
|
|
E. Pimenta, K. K. Gaddam, M. N. Pratt-Ubunama, M. K. Nishizaka, I. Aban, S. Oparil, and D. A. Calhoun Relation of Dietary Salt and Aldosterone to Urinary Protein Excretion in Subjects With Resistant Hypertension Hypertension, February 1, 2008; 51(2): 339 - 344. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. P. Rossi, A. Belfiore, G. Bernini, G. Desideri, B. Fabris, C. Ferri, G. Giacchetti, C. Letizia, M. Maccario, F. Mallamaci, et al. Comparison of the Captopril and the Saline Infusion Test for Excluding Aldosterone-Producing Adenoma Hypertension, August 1, 2007; 50(2): 424 - 431. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. E. Umpierrez, P. Cantey, D. Smiley, A. Palacio, D. Temponi, K. Luster, and A. Chapman Primary Aldosteronism in Diabetic Subjects With Resistant Hypertension Diabetes Care, July 1, 2007; 30(7): 1699 - 1703. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-W. Chang, T.-S. Chu, H.-Y. Huang, S.-C. Chueh, V.-C. Wu, Y.-M. Chen, B.-S. Hsieh, and K.-D. Wu Down-Regulation of D2 Dopamine Receptor and Increased Protein Kinase C{micro} Phosphorylation in Aldosterone-Producing Adenoma Play Roles in Aldosterone Overproduction J. Clin. Endocrinol. Metab., May 1, 2007; 92(5): 1863 - 1870. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Newton-Cheh, C.-Y. Guo, P. Gona, M. G. Larson, E. J. Benjamin, T. J. Wang, S. Kathiresan, C. J. O'Donnell, S. L. Musone, A. L. Camargo, et al. Clinical and Genetic Correlates of Aldosterone-to-Renin Ratio and Relations to Blood Pressure in a Community Sample Hypertension, April 1, 2007; 49(4): 846 - 856. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Stowasser and R. D. Gordon Aldosterone Excess, Hypertension, and Chromosome 7p22: Evidence Continues to Mount Hypertension, April 1, 2007; 49(4): 761 - 762. [Full Text] [PDF]
|
|
|
|
 |
|
 M. N. Pratt-Ubunama, M. K. Nishizaka, R. L. Boedefeld, S. S. Cofield, S. M. Harding, and D. A. Calhoun Plasma Aldosterone Is Related to Severity of Obstructive Sleep Apnea in Subjects With Resistant Hypertension Chest, February 1, 2007; 131(2): 453 - 459. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. P. Rossi, G. Bernini, C. Caliumi, G. Desideri, B. Fabris, C. Ferri, C. Ganzaroli, G. Giacchetti, C. Letizia, M. Maccario, et al. A Prospective Study of the Prevalence of Primary Aldosteronism in 1,125 Hypertensive Patients J. Am. Coll. Cardiol., December 5, 2006; 48(11): 2293 - 2300. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Stowasser and R. D. Gordon Aldosterone Assays: An Urgent Need for Improvement Clin. Chem., September 1, 2006; 52(9): 1640 - 1642. [Full Text] [PDF]
|
|
|
|
|
|
G. P. Rossi, G. Bernini, G. Desideri, B. Fabris, C. Ferri, G. Giacchetti, C. Letizia, M. Maccario, M. Mannelli, M.-J. Matterello, et al. Renal Damage in Primary Aldosteronism: Results of the PAPY Study Hypertension, August 1, 2006; 48(2): 232 - 238. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Mulatero, A. Milan, F. Fallo, G. Regolisti, F. Pizzolo, C. Fardella, L. Mosso, L. Marafetti, F. Veglio, and M. Maccario Comparison of Confirmatory Tests for the Diagnosis of Primary Aldosteronism J. Clin. Endocrinol. Metab., July 1, 2006; 91(7): 2618 - 2623. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Fallo, F. Veglio, C. Bertello, N. Sonino, P. Della Mea, M. Ermani, F. Rabbia, G. Federspil, and P. Mulatero Prevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism J. Clin. Endocrinol. Metab., February 1, 2006; 91(2): 454 - 459. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. L. Schwartz and S. T. Turner Screening for Primary Aldosteronism in Essential Hypertension: Diagnostic Accuracy of the Ratio of Plasma Aldosterone Concentration to Plasma Renin Activity Clin. Chem., February 1, 2005; 51(2): 386 - 394. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.-C. Tiu, C.-H. Choi, C.-C. Shek, Y.-W. Ng, F. K. W. Chan, C.-M. Ng, and A. P. S. Kong The Use of Aldosterone-Renin Ratio as a Diagnostic Test for Primary Hyperaldosteronism and Its Test Characteristics under Different Conditions of Blood Sampling J. Clin. Endocrinol. Metab., January 1, 2005; 90(1): 72 - 78. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Olivieri, A. Ciacciarelli, D. Signorelli, F. Pizzolo, P. Guarini, C. Pavan, A. Corgnati, S. Falcone, R. Corrocher, A. Micchi, et al. Aldosterone to Renin Ratio in a Primary Care Setting: The Bussolengo Study J. Clin. Endocrinol. Metab., September 1, 2004; 89(9): 4221 - 4226. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. H. Perschel, R. Schemer, L. Seiler, M. Reincke, J. Deinum, C. Maser-Gluth, D. Mechelhoff, R. Tauber, and S. Diederich Rapid Screening Test for Primary Hyperaldosteronism: Ratio of Plasma Aldosterone to Renin Concentration Determined by Fully Automated Chemiluminescence Immunoassays Clin. Chem., September 1, 2004; 50(9): 1650 - 1655. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.-F. Plouin, L. Amar, and G. Chatellier Trends in the prevalence of primary aldosteronism, aldosterone-producing adenomas, and surgically correctable aldosterone-dependent hypertension Nephrol. Dial. Transplant., April 1, 2004; 19(4): 774 - 777. [Full Text] [PDF]
|
|
|
|
|
|
P. Mulatero, M. Stowasser, K.-C. Loh, C. E. Fardella, R. D. Gordon, L. Mosso, C. E. Gomez-Sanchez, F. Veglio, and W. F. Young Jr. Increased Diagnosis of Primary Aldosteronism, Including Surgically Correctable Forms, in Centers from Five Continents J. Clin. Endocrinol. Metab., March 1, 2004; 89(3): 1045 - 1050. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Mosso, C. Carvajal, A. Gonzalez, A. Barraza, F. Avila, J. Montero, A. Huete, A. Gederlini, and C. E. Fardella Primary Aldosteronism and Hypertensive Disease Hypertension, August 1, 2003; 42(2): 161 - 165. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. F. Young Jr. Minireview: Primary Aldosteronism--Changing Concepts in Diagnosis and Treatment Endocrinology, June 1, 2003; 144(6): 2208 - 2213. [Abstract] [Full Text] [PDF]
|
|