Ratio of serum aldosterone to plasma renin concentration in essential hypertension and primary aldosteronism

Trenkel, Stefan; Seifarth, C.; Schobel, Hans P.; Hahn, Eckart G.; Hensen, J.

doi:10.1055/s-2002-23491

Cited by 66 publications

(68 citation statements)

References 13 publications

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“…Several studies concluded that mean A PL and PRA values are not significantly influenced by medication in patients with PA. 17 Other data suggest that A PL /PRA ratio or ARR (using plasma renin concentration) are valid screening tools for PA in outpatients with ongoing antihypertensive treatment. 11,13,34,35 The results of this study match well with the data of previously published studies showing that treatment with ACEI or ARB was associated with higher renin concentrations and a lower ARR. 9,17,36 Of note, the effects were more profound in patients with EH.…”

Section: Discussionsupporting

confidence: 89%

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

et al. 2010

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It is suggested to use the aldosterone-to-renin ratio (ARR) as a first test in the screening for primary aldosteronism (PA). However, many groups rather rely on the determination of urinary tetrahydroaldosterone secretion; others calculate a ratio of urinary aldosterone to plasma renin activity. The aim of the present study was to evaluate the usefulness of different parameters of aldosterone excess in the case finding of PA. The study included 28 patients with PA and 33 subjects with essential hypertension. Clinical data, which included the hormonal parameters, serum aldosterone, plasma renin concentration, urinary free aldosterone and metabolites and serum and urinary electrolyte levels were analyzed. These indices of aldosterone excess, the ARR, serum sodium to urinary sodium to (serum potassium) 2 to urinary potassium (SUSPPUP) ratio and combinations of these parameters were compared between the groups. Receiver-operating curve analysis revealed that the ARR multiplied by the SUSPPUP ratio (ARRÂSUSPPUP) is the most reliable screening test, with a sensitivity of 92.3% and a specificity of 93.9% (cutoff point 199.2 (mmol l À1 ) À1 ). The combination of ARRÂSUSPPUP ratio with urinary free aldosterone divided by the plasma renin concentration rendered a specificity of 100%. Less useful was the correction of urinary free aldosterone and its metabolites for sodium excretion. Although the ARR and urinary free aldosterone divided by renin are good tests in the screening for PA, the combination of ARR with SUSPPUP ratio is a better indicator of an aldosterone excess and aldosterone action in patients with ongoing antihypertensive medication. Antihypertensive drugs only marginally interfere with the SUSPPUP ratio, but they may influence the ARR, whereby the effects in PA patients seem to be negligible.

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Section: Discussionsupporting

confidence: 89%

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

et al. 2010

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“…However, we found GR-mediated transactivation by aldosterone, but at concentrations relative to cortisol that are not even reached in primary hyperaldosteronism (36,37). Table 4 Different functional groups and their effects on the glucocorticoid (GC) and mineralocorticoid (MC) activity of a steroid " Enhancement or # attenuation of the glucocorticoid (upper part) or mineralocorticoid activity by functional groups (left column).…”

Section: Discussionmentioning

confidence: 98%

Transactivation via the human glucocorticoid and mineralocorticoid receptor by therapeutically used steroids in CV-1 cells: a comparison of their glucocorticoid and mineralocorticoid properties

et al. 2004

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Background: Glucocorticoids (GCs) are commonly used for long-term medication in immunosuppressive and anti-inflammatory therapy. However, the data describing gluco-and mineralo-corticoid (MC) properties of widely applied synthetic GCs are often based on diverse clinical observations and on a variety of in vitro tests under various conditions, which makes a quantitative comparison questionable. Method: We compared MC and GC properties of different steroids, often used in clinical practice, in the same in vitro test system (luciferase transactivation assay in CV-1 cells transfected with either hMR or hGRa expression vectors) complemented by a system to test the steroid binding affinities at the hMR (protein expression in T7-coupled rabbit reticulocyte lysate). Results and Conclusions: While the potency of a GC is increased by an 11-hydroxy group, both its potency and its selectivity are increased by the D1-dehydro-configuration and a hydrophobic residue in position 16 (16-methylene, 16a-methyl or 16b-methyl group). Almost ideal GCs in terms of missing MC effects, as defined by our in vitro assay, are therefore prednylidene, budesonide, beclomethasone and betamethasone. The MC potency of a steroid is increased by a 9a-or a 6a-fluoro substituent. A hydrophilic substituent in position 16 (like 16-hydroxylation in triamcinolone) decreases both MC and GC properties. As no substituent that leads to an isolated reduction of GC activity could be characterized in our experiments, 9a-fluorocortisol, the most frequently used steroid for MC substitution, seems to be the best choice of available steroids for this purpose.

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“…However, debate concerning the rationale for screening of primary aldosteronism and concerning the best screening test is continuing (23,27,28,30). Opponents of widespread screening within the hypertensive population argue that the benefit for patients with an elevated aldosterone/renin ratio with respect to outcome measures such as mortality and morbidity has not been shown in randomized controlled trials (31).…”

Section: Discussionmentioning

confidence: 99%

Confirmatory testing in normokalaemic primary aldosteronism: the value of the saline infusion test and urinary aldosterone metabolites

Schirpenbach¹,

Seiler²,

Maser-Gluth³

et al. 2006

eur j endocrinol

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Objective: Primary aldosteronism has recently been recognized as the most frequent cause of secondary hypertension. Since most patients are normokalaemic, differentiation to essential hypertension is challenging. As differentiation by baseline aldosterone/renin ratio may be insufficient, diagnosis should be confirmed by additional tests. However, as most confirmatory tests have been evaluated in hypokalaemic primary aldosteronism only, we reassessed the value of the saline infusion test and 24 h urinary aldosterone metabolites as confirmatory tests for both normo-and hypokalaemic primary aldosteronism under current antihypertensive medication. Patients and methods: 25 patients with primary aldosteronism (11 hypokalaemic, 14 normokalaemic), 29 patients with essential hypertension and 47 normotensive subjects were studied. The hypertensives received their usual medication with the exception of spironolactone. All subjects underwent a standard saline infusion test (determination of plasma aldosterone before and after 2.0 liters of isotonic saline for 4 hours i.v.) and collected a 24 h urine sample for examination of urinary tetrahydroaldosterone and aldosterone-18-glucuronide. Results: In hypokalaemic primary aldosteronism the saline infusion test showed a reasonable sensitivity (91%) and specificity (90%). However, the test failed to differentiate sufficiently between essential hypertension and normokalaemic primary aldosteronism (sensitivity 57%, specificity 90%). Similarly, urinary tetrahydroaldosterone had higher sensitivity in hypokalaemic than in normokalaemic primary aldosteronism (sensitivity 64% vs 36%, specificity 100%), whereas for aldosterone-18-glucuronide, no differences in hypo-and normokalaemic primary aldosteronism were found (sensitivity 45% and 43%, specificity 100%). Conclusions: These data show that the saline infusion test as an established test in classical hypokalaemic primary aldosteronism is not a reliable test in the normokalaemic variant of the disease. Due to its low accuracy, determination of urinary aldosterone metabolites did not prove useful in confirming either normo-or hypokalaemic patients. We conclude from our data that these tests should not be used as confirmatory testing in the normokalaemic variant of primary aldosteronism.European Journal of Endocrinology 154 865-873

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Ratio of serum aldosterone to plasma renin concentration in essential hypertension and primary aldosteronism

Cited by 66 publications

References 13 publications

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

Transactivation via the human glucocorticoid and mineralocorticoid receptor by therapeutically used steroids in CV-1 cells: a comparison of their glucocorticoid and mineralocorticoid properties

Confirmatory testing in normokalaemic primary aldosteronism: the value of the saline infusion test and urinary aldosterone metabolites

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