on October 21, 2002
Published online before print October 21, 2002, doi: 10.1161/01.HYP.0000038478.59760.41
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Submitted on June 3, 2002
From the Department of Medicine and Experimental Oncology,
Hypertension Unit, University of Torino, Torino,
Italy. * To whom correspondence should be addressed. E-mail: paolo.mulatero{at}libero.it.
Abstract—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.
Revised on June 13, 2002
Drug Effects on Aldosterone/Plasma
Renin Activity Ratio in Primary Aldosteronism
Paolo Mulatero*;
Key words: aldosterone • renin • antihypertensive therapy • plasma
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