Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism.
Primary aldosteronism is a specifically treatable and potentially curable form of secondary hypertension. The aldosterone/plasma renin activity ratio (ARR) is routinely used as a screening test. Antihypertensive therapy can interfere with the interpretation of this parameter, but a correct washout period can be potentially harmful. We have investigated the effects of therapy with atenolol, amlodipine, doxazosin, fosinopril, and irbesartan on the ARR in a group of 230 patients with suspected primary aldosteronism. The percent change from control of ARR in patients taking amlodipine was -17%+/-32; atenolol, 62%+/-82; doxazosin, -5%+/-26; fosinopril, -30%+/-24; and irbesartan, -43%+/-27. The ARR change induced by atenolol was significantly higher compared with that induced by all other drugs (P<0.0001), and the ARR change induced by irbesartan was significantly lower than that induced by doxazosin (P<0.0001). One of 55 patients from the group taking amlodipine (1.8%) and 4/17 of the patients taking irbesartan (23.5%) gave a false-negative ARR (<50). None of the patients of the groups taking fosinopril, doxazosin, and atenolol displayed a false-negative ARR. Doxazosin and fosinopril can be used in hypertensive patients who need to undergo aldosterone and PRA measurement for the diagnosis of primary aldosteronism; amlodipine gave a very small percentage of false-negative diagnoses. beta-Blockers also do not interfere with the diagnosis of primary aldosteronism, but they can be responsible for an increased rate of false-positive ARRs. The high rate of false-negative diagnoses in patients undergoing irbesartan treatment requires confirmation in a higher number of patients.
Mulatero
Paolo
P
Department of Medicine and Experimental Oncology, Hypertension Unit, University of Torino, Torino, Italy. paolo.mulatero@libero.it
Rabbia
Franco
F
Milan
Alberto
A
Paglieri
Cristina
C
Morello
Fulvio
F
Chiandussi
Livio
L
Veglio
Franco
F
D000450:Aldosterone / Q000097:blood*; D017311:Amlodipine / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001262:Atenolol / Q000009:adverse effects / Q000627:therapeutic use; D001713:Biphenyl Compounds / Q000009:adverse effects / Q000627:therapeutic use; D015986:Confounding Factors, Epidemiologic; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000592:standards; D017292:Doxazosin / Q000009:adverse effects / Q000627:therapeutic use; D005188:False Negative Reactions; D005189:False Positive Reactions; D017328:Fosinopril / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D000077405:Irbesartan; D008875:Middle Aged; D011237:Predictive Value of Tests; D012083:Renin / Q000097:blood*; D012084:Renin-Angiotensin System / Q000187:drug effects; D012680:Sensitivity and Specificity; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D013777:Tetrazoles; D017311:Amlodipine; D000450:Aldosterone; D001262:Atenolol; D012083:Renin; D000077405:Irbesartan; D017292:Doxazosin; D017328:Fosinopril