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Scientific Contributions

Drug Effects on Aldosterone/Plasma Renin Activity Ratio in Primary Aldosteronism

Paolo Mulatero, Franco Rabbia, Alberto Milan, Cristina Paglieri, Fulvio Morello, Livio Chiandussi, Franco Veglio
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https://doi.org/10.1161/01.HYP.0000038478.59760.41
Hypertension. 2002;40:897-902
Originally published December 1, 2002
Paolo Mulatero
From the Department of Medicine and Experimental Oncology, Hypertension Unit, University of Torino, Torino, Italy.
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Franco Rabbia
From the Department of Medicine and Experimental Oncology, Hypertension Unit, University of Torino, Torino, Italy.
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Alberto Milan
From the Department of Medicine and Experimental Oncology, Hypertension Unit, University of Torino, Torino, Italy.
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Cristina Paglieri
From the Department of Medicine and Experimental Oncology, Hypertension Unit, University of Torino, Torino, Italy.
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Fulvio Morello
From the Department of Medicine and Experimental Oncology, Hypertension Unit, University of Torino, Torino, Italy.
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Livio Chiandussi
From the Department of Medicine and Experimental Oncology, Hypertension Unit, University of Torino, Torino, Italy.
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Franco Veglio
From the Department of Medicine and Experimental Oncology, Hypertension Unit, University of Torino, Torino, Italy.
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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. β-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.

  • aldosterone
  • renin
  • antihypertensive therapy
  • plasma
  • Received June 3, 2002.
  • Revision received June 13, 2002.
  • Accepted September 10, 2002.
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December 2002, Volume 40, Issue 6
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    Drug Effects on Aldosterone/Plasma Renin Activity Ratio in Primary Aldosteronism
    Paolo Mulatero, Franco Rabbia, Alberto Milan, Cristina Paglieri, Fulvio Morello, Livio Chiandussi and Franco Veglio
    Hypertension. 2002;40:897-902, originally published December 1, 2002
    https://doi.org/10.1161/01.HYP.0000038478.59760.41

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    Drug Effects on Aldosterone/Plasma Renin Activity Ratio in Primary Aldosteronism
    Paolo Mulatero, Franco Rabbia, Alberto Milan, Cristina Paglieri, Fulvio Morello, Livio Chiandussi and Franco Veglio
    Hypertension. 2002;40:897-902, originally published December 1, 2002
    https://doi.org/10.1161/01.HYP.0000038478.59760.41
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