Unadjusted Plasma Renin Activity as a “First‐Look” Test to Decide Upon Further Investigations for Primary Aldosteronism

The authors sought to define the 95th percentile of plasma renin activity (PRA) in a sample of patients with confirmed primary aldosteronism (PA) prior to adjustment of medications as a practical “first‐look” test to identify those with very low ultimate likelihood of having PA. The aldosterone to r...

Full description

Saved in:
Bibliographic Details
Published inThe journal of clinical hypertension (Greenwich, Conn.) Vol. 17; no. 7; pp. 541 - 546
Main Authors Rye, Peter, Chin, Alex, Pasieka, Janice, So, Benny, Harvey, Adrian, Kline, Gregory
Format Journal Article
LanguageEnglish
Published United States John Wiley and Sons Inc 01.07.2015
Subjects
Adult
Aldosterone - blood
Antihypertensive Agents - therapeutic use
Body Mass Index
Female
Humans
Hyperaldosteronism - blood
Hyperaldosteronism - diagnosis
Hyperaldosteronism - drug therapy
Hyperaldosteronism - surgery
Hypertension - blood
Hypertension - drug therapy
Male
Middle Aged
Mineralocorticoid Receptor Antagonists - therapeutic use
Original Paper
Renin - blood
Retrospective Studies
Spironolactone - therapeutic use
Tomography, X-Ray Computed
Online AccessGet full text

Cover

More Information
Summary:The authors sought to define the 95th percentile of plasma renin activity (PRA) in a sample of patients with confirmed primary aldosteronism (PA) prior to adjustment of medications as a practical “first‐look” test to identify those with very low ultimate likelihood of having PA. The aldosterone to renin ratio (ARR) was measured without adjustment of antihypertensive medications, with further workup as appropriate. Two groups were defined: patients with surgically “confirmed PA” (n=58) and patients with “high‐probability PA” (n=59), defined as having any of the following: computed tomography–confirmed adrenal adenoma plus lateralizing adrenal vein sampling (AVS) without surgery, high ARR and hypokalemia but nonlateralizing AVS, or ARR more than four times the upper limit of normal. The PRA 95th percentile was 1.0 ng/mL/h. All outliers had hypokalemia and two had adrenal adenomas. There was no difference between the confirmed and high probability groups. In the absence of highly suspicious clinical features, patients with unadjusted PRA >1.0 ng/mL/h do not warrant further investigation for PA.
ISSN:1524-6175
1751-7176
DOI:10.1111/jch.12523