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Konstantinos Petidis, Stella Douma, Konstantinos Vogiatzis, Sofia Moutafidou, Panayota Papaefthimiou, Chrysanthos Zamboulis, P-611: The application of the aldosterone/PRA ratio (ARR) in the diagnosis of primary aldosteronism, American Journal of Hypertension, Volume 14, Issue S1, April 2001, Page 234A, https://doi.org/10.1016/S0895-7061(01)01918-5
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Abstract
Primary aldosteronism (PA) is a rare cause of secondary hypertension and hypokalemia is traditionally considered its main finding. Recently it has been appreciated that hypokalemia may be transient and certainly less common.The use of ratio of Aldosterone/PRA (>30: indicative of PA) has been proposed as the initial screening test. The purpose of our study was to evaluate the application of the ALD/PRA ratio (ARR) in the diagnosis of primary aldosteronism.
Patients-Methods: We screened 978 patients who presented with hypertension resistant to antihypertensive treatment, of non-renal origin, accompanied or not by hypokalemia. Aldosterone and PRA were measured in the supine position. Suppression tests with NaCl loading and Fludrocortisone were performed and blood pressure response to spironolactone was monitored. The diagnosis of Aldosteronism was confirmed in patients with high serrum Aldosterone and high ARR who failed to suppress their Aldosterone levels during the suppression tests. Normalization of blood pressure after the administration of spironolactone was considered necessary for the diagnosis of aldosteronism.
Results: From the 987 patients screened, 211 had ARR >30 accompanied by high levels of Aldosterone. After suppression tests and positive response to treatment with spironolactone Aldosteronism was diagnosed in 137/211. In another 11 patients with high ARR and ALD at the high normal levels primary aldosteronism was also diagnosed. In total we established the diagnosis of PA in 148 patients from the initially screened.High ARR has high sensitivity (92.6%) and specificity (91.6%) in diagnosing patients with suspected primary aldosteronism. In our patients with primary aldosteronism 41% had hypokalemia and 83% had abnormal findings in adrenal CT (adenoma in 37% and hyperplasia in 46%).
Conclusion: High ARR is much more helpful than hypokalemia or adrenal CT as the initial screening test in the diagnosis of primary aldosteronism.
