Urinary Aldosterone-to-active-renin Ratio: A Useful Tool for Predicting Resolution of Hypertension After Adrenalectomy in Patients With Aldosterone-producing Adenomas

Mourad, Jean‐Jacques; Girerd, Xavier; Milliez, P; Lopez‐Sublet, Marilucy; Lejeune, Sibille; Safar, Michel E.

doi:10.1038/ajh.2008.175

Cited by 24 publications

(17 citation statements)

References 37 publications

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“…This is in line with previous observations that also showed that the A UR /R ratio is also of good predictive value whether or not hypertension is reversible after adrenalectomy for APA. 19,20 As a limitation, most of the PA patients were under antihypertensive therapy at the time of screening and the present retrospective study did not assess the influence of various antihypertensive drugs on the laboratory parameters. In addition, sodium intake also influences the ARR and the current study did not analyze the effect of low sodium intake versus high sodium intake on the aldosterone excess parameters in the same patients.…”

Section: Discussionmentioning

confidence: 90%

“…The urinary unconjugated (free) aldosterone-to-active renin ratio (A UR /R) proved to be a good independent predictor for surgical curability after adrenalectomy, in subjects with aldosteroneproducing adenomas (APAs). 19,20 Recently, our group has shown the usefulness of the serum sodium to urinary sodium to (serum potassium) 2 to urinary potassium (SUSPPUP) ratio in the diagnosis of PA. When calculated from synchronous measurements of sodium and potassium in serum as well as in urine in a fasting state, the SUSPPUP ratio reflects the mineralocorticoid excess and was proposed as a cheap and rapid tool in the screening for PA. 21 The present study was performed to assess the usefulness of different parameters in the first line screening for PA, including correction for plasma renin concentration or/and urinary sodium excretion.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

et al. 2010

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“…28,29 Based on age, diabetes mellitus, and angina pectoris, which remained significant in a multivariate model, we calculated a sum score associated with an adverse outcome. As shown in Figure 2, patients with a score of Ն2 had an increased risk for death.…”

Section: Discussionmentioning

confidence: 99%

Observational Study Mortality in Treated Primary Aldosteronism

et al. 2012

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Abstract-In comparison with essential hypertension, primary aldosteronism (PA) is associated with an increased risk of cardiovascular morbidity. To date, no data on mortality have been published. We assessed mortality of patients treated for PA within the German Conn's registry and identified risk factors for adverse outcome in a case-control study.Patients with confirmed PA treated in 3 university centers in Germany since 1994 were included in the analysis. All of the patients were contacted in 2009 and 2010 to verify life status. Subjects from the population-based F3 survey of the Cooperative Health Research in the Region of Augsburg served as controls. Final analyses were based on 600 normotensive controls, 600 hypertensive controls, and 300 patients with PA. Kaplan-Meyer survival curves were calculated for both cohorts. Ten-year overall survival was 95% in normotensive controls, 90% in hypertensive controls, and 90% in patients with PA (P value not significant). In multivariate analysis, age (hazard ratio, 1.09 per year [95% CI, 1.03-1.14]), angina pectoris (hazard ratio, 3.6 [95% CI, 1.04 -12.04]), and diabetes mellitus (hazard ratio, 2.55 [95% CI, 1.07-6.09]) were associated with an increase in all-cause mortality, whereas hypokalemia (hazard ratio, 0.41 per mmol/L [95% CI, 0.17-0.99]) was associated with reduced mortality. Cardiovascular mortality was the main cause of death in PA (50% versus 34% in hypertensive controls; PϽ0.05). These data indicate that cardiovascular mortality is increased in patients treated for PA, whereas all-cause mortality is not different from matched hypertensive controls. (Hypertension. 2012;60:618-624.) • Online Data Supplement Key Words: Conn syndrome Ⅲ aldosterone Ⅲ renin Ⅲ cardiovascular Ⅲ morbidity Ⅲ mortality A ldosterone is a key regulator of fluid and electrolyte balance in human physiology. Aldosterone excess in the presence of a high-sodium diet raises blood pressure. High blood pressure, together with direct proinflammatory and profibrotic effects of aldosterone on the vessel wall, causes and sustains cardiovascular atherosclerosis. 1,2 In keeping with these findings, high aldosterone levels are associated with mortality in heart failure cohorts, 3 and blockade of the renin-angiotensin-aldosterone system by mineralocorticoid antagonists improves outcome in heart failure and after myocardial infarction. 4,5 The contribution of aldosterone to the development of arterial hypertension in the general population has been suggested by the Framingham Offspring Study, in which plasma aldosterone levels in normotensive subjects predicted subsequent increases in blood pressure and the development of hypertension. 6 Recent evidence suggests that primary aldosteronism (PA) is more common than previously thought. 7 Several studies have provided evidence that patients with PA are especially prone to cardiovascular and renal complications. In a recent study by Catena et al, 8 aldosterone excess caused left ventricular hypertrophy and diastolic dysfunction independent of blood pressu...

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“…Some studies have presented results showing that older age, larger tumor size, higher urinary aldosterone-renin ratio, higher BMI, and family history of hypertension are factors affecting the complete hypertension cure after adrenalectomy [9,10,11,16]. In particular, a recent study that used ARS to determine the score found female gender, use of ≤2 antihypertensive agents, BMI <25, and duration of hypertension <6 years to be good predictors [10].…”

Section: Discussionmentioning

confidence: 99%

“…More interestingly, Zarnegar et al [10] recently developed the Aldosteronoma Resolution Score (ARS), which is a simple scoring system to help clinicians predict the likelihood of complete hypertension cure after adrenalectomy. However, several studies found no association with complete hypertension cure for each of the supposed factors [11,12,13,14,15,16]. Furthermore, Steichen et al [4] pointed out that the ARS models, the only prediction model validated to date, provide only a weak prediction of hypertension cure in individual patients.…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Complete Hypertension Cure after Adrenalectomy for Aldosterone-Producing Adenoma: Outcomes in a Large Series

Zhang

Zhu

et al. 2013

Urol Int

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Objective: The purpose of this study was to evaluate the impact of hypokalemia on hypertension outcomes in patients with aldosterone-producing adenoma (APA) after adrenalectomy and to determine the factors affecting complete hypertension cure in a large series. Methods: Characteristics from 376 APA patients treated with adrenalectomy between 2005 and 2011 were collected from our center. Factors affecting complete hypertension cure were assessed using logistic regression. Results: At the end of follow-up, 207 (55.05%) patients were completely cured, whereas 138 (36.7%) patients were improved, and 31 (8.3%) patients remain refractory. Age (p = 0.028), >2 antihypertensive agents (p < 0.001), duration of hypertension (p < 0.001), duration of hypokalemia (p = 0.037), systolic blood pressure (p = 0.016), and level of plasma aldosterone (p < 0.001) were associated with hypertension outcomes in univariate analysis. However, multivariate logistic regression analysis showed that only duration of hypertension ≥6 years (OR = 0.496, 95% CI 0.323-0.762, p = 0.001) and level of plasma aldosterone ≥35 ng/dl (OR = 0.503, 95% CI 0.326-0.776, p = 0.002) were the significantly independent factors affecting complete hypertension cure. Conclusions: This is the largest series to show that only duration of hypertension and level of plasma aldosterone were the factors affecting complete hypertension cure after adrenalectomy for APA. This study highlights the importance of early diagnosis and early adrenalectomy.

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Urinary Aldosterone-to-active-renin Ratio: A Useful Tool for Predicting Resolution of Hypertension After Adrenalectomy in Patients With Aldosterone-producing Adenomas

Cited by 24 publications

References 37 publications

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

Observational Study Mortality in Treated Primary Aldosteronism

Factors Affecting Complete Hypertension Cure after Adrenalectomy for Aldosterone-Producing Adenoma: Outcomes in a Large Series

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