Published online before print October 21, 2002, doi: 10.1161/01.HYP.0000038478.59760.41
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(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
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