Unadjusted Plasma Renin Activity as a "First-Look" Test to Decide Upon Further Investigations for Primary Aldosteronism.

The Journal of Clinical Hypertension
Peter RyeGregory A Kline

Abstract

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.

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Citations

Mar 11, 2015·The Journal of Clinical Hypertension·Michael DoumasVasilios Papademetriou
Nov 24, 2016·The Journal of Clinical Hypertension·Gudbjörg JonsdottirHelga Agusta Sigurjonsdottir
Oct 11, 2017·American Journal of Hypertension·Gregory A KlineErnesto L Schiffrin
Apr 17, 2019·Current Hypertension Reviews·Konstantinos StavropoulosMichael Doumas
Nov 5, 2016·The Journal of Clinical Endocrinology and Metabolism·Rene BaudrandAnand Vaidya
Oct 26, 2018·Circulation·James Brian ByrdRichard J Auchus
Jul 20, 2017·The Journal of Clinical Hypertension·Konstantinos StavropoulosMichael Doumas
Oct 28, 2019·Endocrinology and Metabolism Clinics of North America·Gregory L Hundemer, Anand Vaidya
Dec 16, 2019·Best Practice & Research. Clinical Endocrinology & Metabolism·Yuhong YangTracy Ann Williams

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