Screening for primary aldosteronism without discontinuing hypertensive medications: Plasma aldosterone-renin ratio
Abstract
The traditional workup for primary aldosteronism is cumbersome and requires discontinuing antihypertensive medications, which is inconvenient and potentially dangerous. A simple and accurate screening test that can be used without modifying medications is needed. The plasma aldosterone-renin ratio (ARR) is a valid screening assay for primary aldosteronism, but antihypertensives are usually discontinued before obtaining this ratio, limiting its utility. The present prospective study is designed to examine the validity of the ARR as a screening test for primary aldosteronism if the ratio is measured randomly while patients continue antihypertensive therapy. During the 18-month study period, 90 patients were referred to the hypertension clinic with poorly controlled hypertension. ARR was measured in random blood samples in all 90 patients while maintaining their prescribed antihypertensive medications. Those with elevated ARRs (>100 ng/dL / ng/mL/h) underwent further diagnostic workup, including adrenal computed tomography and/or magnetic resonance imaging and adrenal iodine 131 norcholesterol uptake scan. Fifteen patients (17%) had elevated ARRs greater than 100:1. Ten of 15 patients were found to have adrenal adenoma on diagnostic workup, and adenoma was later confirmed by histological examination after surgical removal in these 10 patients. Five patients were found to have adrenal hyperplasia; all 5 patients responded to antialdosterone treatment. Thus, all 15 patients had good control of blood pressure after surgery and/or antialdosterone medications. No patient showed a falsely elevated ARR. Data suggest that the ARR is a valid screening assay for primary aldosteronism in patients with poorly controlled blood pressure, and discontinuation of antihypertensive medications is not needed for this test.
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Observational studies from many different countries have demonstrated a prevalence rate of primary aldosteronism of ≈20% in patients with confirmed resistant hypertension.
“Observational studies from many different countries have demonstrated a prevalence rate of primary aldosteronism of ≈20% in patients with confirmed RH.57,160,294–296”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [294]
The majority of studies indicate that primary aldosteronism is a particularly common cause of resistant hypertension.
“The majority of studies indicate that primary aldosteronism is a particularly common cause of RH.”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [294]
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- Authors
- Gallay, B. J., Ahmad, S., Xu, L., Toivola, B., & Davidson, R. C.
- Affiliations
- University of Washington (US)
- Corresponding author
- Davidson, Robert C.
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2001-04
- Volume
- 37
- Issue
- 4
- Pages
- 699-705
- ISSN
- 0272-6386 (ISSN-L)
- OpenAlex
- W2085100607
- Cited by
- 304
- References
- 20
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 7 · 2020: 8 · 2019: 5 · 2018: 4 · 2017: 9 · 2016: 13 · 2015: 14 · 2014: 9 · 2013: 21 · 2012: 14
- FWCI
- 11.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Washington
- Javna Agencija za Raziskovalno Dejavnost RS
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- primary aldosteronism, screening test, antihypertensive drugs, uncontrolled hypertension, adrenal adenoma, adrenal hyperplasia, adrenal imaging, false positives
- MeSH terms
- Adenoma, Adrenal Gland Neoplasms, Adult, Aldosterone, Antihypertensive Agents, Female, Humans, Hyperaldosteronism, Hypertension, Male, Middle Aged, Prospective Studies, Renin
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