Objective
To determine whether the calculated ratio of plasma aldosterone concentration (PAC)
to plasma renin activity (PRA), a proposed screening test for primary aldosteronism,
provides a renin-independent measure of circulating aldosterone that is suitable to
judge whether PAC is inappropriately elevated relative to PRA.
Subjects and Methods
This study consisting of 221 black and 276 white subjects with previously diagnosed
essential hypertension was conducted between 1996 and 2000. Antihypertensive drugs
were withdrawn for at least 4 weeks; PAC and PRA were measured while subjects were
supine and then seated after 30 minutes of ambulation. The seated measurements were
repeated after 4 weeks of oral diuretic therapy with hydrochlorothiazide (25 mg/d).
Results
The variation in the aldosterone-renin ratio was strongly and inversely dependent
on PRA (R2=0.71; P<.001). When subjects changed position from supine to seated, the increase in mean
± SD PRA (from 1.18±1.06 to 1.31±1.19 ng·mL−1·h−1; P<.001) was associated with an increase in the mean ratio (from 18.6±52.8 to 25.8±38.1
h·102; P<.001), whereas the increase in mean ± SD PRA in response to diuretic therapy (from
1.31±1.19 to 2.72±2.67 ng·mL−1·h−1; P=.007) was associated with a decrease in the mean ratio (from 25.8±38.1 to 16.4±31.6
h·102; P<.001).
Conclusion
In patients with previously diagnosed essential hypertension, calculation of the aldosterone-renin
ratio does not provide a renin-independent measure of circulating aldosterone that
is suitable for determining whether PAC is elevated relative to PRA. Because elevation
of the aldosterone-renin ratio is predominantly an indicator of low PRA, its perceived
value in screening for primary aldosteronism most likely derives from additional diagnostic
tests being done in patients with low-renin hypertension.
Abbreviations:
PAC (plasma aldosterone concentration), PRA (plasma renin)To read this article in full you will need to make a payment
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Article Info
Footnotes
This study was supported in part by US Public Health Service grants R01-HL53330, M01-RR00585, and M01-RR00039 and funds from the Mayo Foundation.
For editorial comment, see page 875.
Identification
Copyright
© 2001 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
