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Paolo Mulatero, Franco Rabbia, Alberto Milan, Fulvio Morello, Giannina Leotta, Sara Del Colle, Mimma Caserta, Mirko Tredici, Franco Veglio, P-593: Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism: , American Journal of Hypertension, Volume 16, Issue S1, May 2003, Page 253A, https://doi.org/10.1016/S0895-7061(03)00766-0
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Abstract
We investigated the effect of atenolol, amlodipine, doxazosin, fosinopril, and irbesartan on the aldosterone/plasma renin activity ratio (ARR). ARR is routinely used as a screening test for primary aldosteronism, a common and specifically treatable form of secondary hypertension. Antihypertensive drugs can interfere with the interpretation of ARR, but a correct washout period can be potentially harmful. We measured ARR during single-drug therapy and after a 1-month washout period in a group of 230 patients with hypertension referred to our unit. The percent change 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), while 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. These data suggest that 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. β-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.
