title: Effects of two selective serotonin reuptake inhibitor antidepressants, sertraline and escitalopram, on aldosterone/renin ratio in normotensive depressed male patients.
abstract: BACKGROUND
  Plasma aldosterone to renin ratio (ARR) is the most popular screening test for primary aldosteronism (PAL). Certain medications are known to cause false-negative or -positive ARRs by affecting renin and aldosterone levels. There are no previously published data on the effects of antidepressants on ARR.
  
  
  METHODS
  Normotensive, depressed male patients (n = 26) underwent measurement (seated, midmorning) of plasma aldosterone, direct renin concentration (DRC), renin activity (PRA), electrolytes and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline and after 2 and 6 wk treatment with sertraline (n = 14) or escitalopram (n = 12).
  
  
  RESULTS
  For both antidepressants, treatment was associated with rises in aldosterone [sertraline: baseline, mean ± sd, 243 ± 34; 2 wk, 256 ± 33; 6 wk, 267 ± 34 pmol/liter (P < 0.01 by ANOVA); escitalopram, 261 ± 36, 269 ± 38, 282 ± 40 pmol/liter (P < 0.05)], DRC [19.5 ± 2.2, 33.5 ± 2.0, 39.0 ± 2.4 mU/liter (P < 0.001); 24.5 ± 2.4, 34.0 ± 2.7, 42.8 ± 2.4 mU/liter (P < 0.001)], and PRA [2.24 ± 0.21, 2.58 ± 0.26, 4.68 ± 0.42 ng/ml · h (P < 0.001); 4.31 ± 0.22, 5.57 ± 0.36, 6.42 ± 0.53 ng/ml · h (P < 0.001)]. ARR fell significantly whether calculated using DRC [sertraline, 13.7 ± 2.2, 7.5 ± 0.7, 6.8 ± 0.7 (P < 0.001); escitalopram, 11.5 ± 1.9, 8.0 ± 1.1, 6.6 ± 1.0 (P < 0.001)], or PRA [116.6 ± 15.8, 108.4 ± 15.6, 60.4 ± 6.2 (P < 0.001); 61.2 ± 8.1, 50.0 ± 7.7, 45.6 ± 6.0 (P < 0.01)].
  
  
  CONCLUSIONS
  Selective serotonin reuptake inhibitor antidepressants can significantly reduce ARR and therefore potentially increase the risk of false-negative results when screening for PAL. Further studies in hypertensive patients, including patients with confirmed PAL, are required.
authors.affiliation: Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane 4102, Australia.
authors.forename: Ashraf H
authors.initials: AH
authors.lastname: Ahmed
authors.forename: Michele
authors.initials: M
authors.lastname: Calvird
authors.forename: Richard D
authors.initials: RD
authors.lastname: Gordon
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Taylor
authors.forename: Gregory
authors.initials: G
authors.lastname: Ward
authors.forename: Eduardo
authors.initials: E
authors.lastname: Pimenta
authors.forename: Ross
authors.initials: R
authors.lastname: Young
authors.forename: Michael
authors.initials: M
authors.lastname: Stowasser
mesh_terms: D000328:Adult; D000450:Aldosterone / Q000097:blood* / Q000378:metabolism; D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D015283:Citalopram / Q000494:pharmacology* / Q000627:therapeutic use; D003863:Depression / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology / Q000652:urine; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis; D008297:Male; D012083:Renin / Q000097:blood* / Q000378:metabolism; D012084:Renin-Angiotensin System / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D020280:Sertraline / Q000494:pharmacology* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000450:Aldosterone; D000928:Antidepressive Agents; D015283:Citalopram; D006854:Hydrocortisone; D012083:Renin; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline