title: Effect of postural changes on aldosterone to plasma renin ratio in patients with suspected secondary hypertension.
abstract: OBJECTIVE
  To study the influence of postural changes on aldosterone to renin ratio (ARR) in patients with suspected secondary hypertension and to evaluate the sensitivity and specificity of the recommended seated ARR compared to supine and upright ARR for primary aldosteronism screening.
  
  
  METHODS
  Fifty-three hypertensive patients were prospectively hospitalized for secondary hypertension exploration (age: 51 ± 12, 66% males). After withdrawal of drugs interfering with renin angiotensin system, plasma aldosterone and direct renin concentration were measured in the morning, at bed after an overnight supine position, then out of bed after 1 hour of upright position and finally 2 hours later after 15 minutes of seating. Minimal renin value was set at 5 μUI/mL.
  
  
  RESULTS
  Referring to ARR cut-off of 23 pg/μUI, the sensitivity of seated ARR was 57.1% and specificity was 92.3%. The negative and positive predictive values were 95.1% and 45.2% respectively. Compared to these results, a cut-off of 19 improved sensitivity to 85.7% with a specificity of 89.7%. Negative and positive predictive values were 98.3% and 41.1% respectively. Seated ARR mean value was lower than supine and upright ARR mean values, due to an overall increase in renin at seating compared to the supine position by factor 1.9 while aldosterone just slightly increased by factor 1.2. Seated ARR correlated to supine and upright ARR: correlation coefficients (r) 0.90 and 0.93 respectively (P<0.001).
  
  
  CONCLUSIONS
  Current recommended measurement of ARR in the seating position is fairly correlated to supine and upright ARR. A suggested cut-off value of 19 instead of 23 pg/μUI increased the discriminating power of this test.
authors.affiliation: Pôle cardiovasculaire et métabolique, service de médecine interne et hypertension artérielle, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France. Electronic address: med_barigou@yahoo.fr.
authors.forename: M
authors.initials: M
authors.lastname: Barigou
authors.affiliation: Pôle cardiovasculaire et métabolique, service de médecine interne et hypertension artérielle, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: F
authors.initials: F
authors.lastname: Ah-Kang
authors.affiliation: Pôle cardiovasculaire et métabolique, service de médecine interne et hypertension artérielle, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: E
authors.initials: E
authors.lastname: Orloff
authors.affiliation: Pôle cardiovasculaire et métabolique, service de médecine interne et hypertension artérielle, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: J
authors.initials: J
authors.lastname: Amar
authors.affiliation: Pôle cardiovasculaire et métabolique, service de médecine interne et hypertension artérielle, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Chamontin
authors.affiliation: Pôle cardiovasculaire et métabolique, service de médecine interne et hypertension artérielle, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Bouhanick
mesh_terms: D000450:Aldosterone / Q000097:blood*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D006973:Hypertension / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011187:Posture; D011446:Prospective Studies; D012083:Renin / Q000097:blood*
chemical_list: D000450:Aldosterone; D012083:Renin
keywords: Aldosterone; Aldostérone; Assis; Couché; Hyperaldostéronisme primaire; Hypertension secondaire; Primary aldosteronism; Rapport; Ratio; Renin; Rénine; Seated; Secondary hypertension; Sensibilité; Sensitivity; Specificity; Spécificité; Supine