Optimal use and interpretation of the aldosterone renin ratio to detect aldosterone excess in hypertension

Journal of Human Hypertension
S A R DoiK A S Al-Shoumer

Abstract

With the introduction of the aldosterone/renin ratio as a screening test, the detection rate of primary aldosteronism has increased considerably. Nevertheless, no consensus has so far been reached regarding the cutoff points, operating characteristics or indeed even the reference values for reporting the aldosterone/renin ratio using plasma active renin (ng/l or mU/l) measured by immunoradiometric assay. We review the characteristics of this ratio in normal individuals, essential hypertension and primary hyperaldosteronism in an attempt to reach an agreement regarding its optimum use and interpretation - both using the renin activity or concentration. It seems that the optimal cutoff for patients with primary aldosteronism is above 30 ng/dl per mug/l/h or 800 pmol/l per mug/l/h or 130 pmol/ng or 80 pmol/mU. We explore enhancing measures such as captopril loading or use with a plasma aldosterone cutoff as well as pitfalls with the test such as confounding medications or the need for confirmatory testing. For the latter, demonstration of autonomous aldosterone production via salt loading is widely used, but may not be most advantageous and may even be contraindicated in patients with severe hypertension. The renin stimulation tes...Continue Reading

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Citations

Jun 26, 2013·Trends in Endocrinology and Metabolism : TEM·Sandi-Jo GalatiAlice C Levine
Jun 4, 2010·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Melania BalaşHolger S Willenberg
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Jun 4, 2015·Endocrinology and Metabolism Clinics of North America·Sandi-Jo Galati
May 31, 2017·Nephrology·Jun YangPeter J Fuller

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