title: The prevalence of a raised aldosterone-renin ratio (ARR) among new referrals to a hypertension clinic.
abstract: The wider application of the plasma aldosterone to renin activity ratio (ARR) test has led independent groups to report a 10-fold or higher prevalence in the detection and prevalence of primary aldosteronism than previously suggested, although such figures have been contested. We determined the prevalence of a raised ARR in an unselected group of patients who were referred to the hypertension clinic at Aberdeen Royal Infirmary. Over a 4-month period, all newly referred patients had an ARR, urea and electrolytes, and 24-h ambulatory blood pressure monitoring (ABPM) performed in addition to a detailed clinical examination. One hundred and twenty-two patients (mean age 51 +/- 16 years) were examined over the study period; 57 (47%) were receiving no anti-hypertensive medication, 32(26% of total) had a normal 24-h ABPM of which 15 patients were receiving antihypertensive medication ("controlled" hypertensives) and 17(14%) were receiving no anti-hypertensive medication ("white-coat hypertensives). Twenty patients (mean age 58 +/- 11 years) were found to have a raised ARR (> 750), of which 10 patients were receiving beta-blocker therapy as part of their anti-hypertensive regimen. Patients with a raised ARR were more likely (odds ratio 3.6, 95% confidence interval 1.2-13.2, p < 0.05) to be classified as a "non-dipper" compared with those whose blood pressure fell at night. The proportion of newly referred hypertensive patients with a raised ARR is still significant and confirms that of previous studies The ratio appears to be significantly driven by a suppressed renin value and further investigation is required to clarify the status of those patients receiving anti-hypertensive medications, particularly beta-blockers.
authors.affiliation: Department of Clinical Pharmacology, Aberdeen Royal Infirmary, Aberdeen, UK. David.J.Williams@arh.grampian.scot.nhs.uk
authors.forename: D
authors.initials: D
authors.lastname: Williams
authors.forename: B
authors.initials: B
authors.lastname: Croal
authors.forename: J
authors.initials: J
authors.lastname: Furnace
authors.forename: S
authors.initials: S
authors.lastname: Ross
authors.forename: K
authors.initials: K
authors.lastname: Witte
authors.forename: M
authors.initials: M
authors.lastname: Webster
authors.forename: W
authors.initials: W
authors.lastname: Critchen
authors.forename: J
authors.initials: J
authors.lastname: Webster
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D000554:Ambulatory Care Facilities; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012017:Referral and Consultation; D012083:Renin / Q000097:blood*; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents; D000450:Aldosterone; D012083:Renin