A real-world study on the impact of antihypertensive drugs on screening tests for primary aldosteronism_West China Medical Journal

Authors：

WU Xi ^1,2 , ZHAO Lianling ¹ , REN Yan ¹ , TIAN Haoming ¹ ,  CHEN Tao ¹

1. Department of Endocrinology & Metabolism, Adrenal Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Endocrinology and Metabolism, the People’s Hospital of Jianyang City, Jianyang, Sichuan 641400, P. R. China;

Corresponding?author：

CHEN Tao, Email: dr.chentao@qq.com

Keywords：

Primary aldosteronism; renin activity; aldosterone; antihypertensive drugs

DOI：

10.7507/1002-0179.202310038

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the effect of antihypertensive agents on primary aldosteronism (PA) screening test in the real world clinical practice; to explore the antihypertensive regimen and the corresponding aldosterone versus renin ratio (ARR) cut-off point of hypertension patients undergoing PA screening. Methods Hypertensive patients who underwent PA screening in the Department of Endocrinology & Metabolism of West China Hospital of Sichuan University between January 2010 and December 2020 were selected. According to the PA diagnostic criteria, patients were divided into the PA group and the essential hypertension (EH) group. The antihypertensive drugs, diastolic blood pressure, systolic blood pressure, blood electrolyte, plasma renin activity, plasma aldosterone, ARR were collected before and after the washout period; aldosterone before and after captopril test, and aldosterone before and after saline infusion test were collected. The above indicators of the two groups of patients were compared and analyzed. Results A total of 488 patients were included. Among them, there were 391 cases in the PA group and 97 cases in the EH group. There were statistically significant differences in age, systolic blood pressure, diastolic blood pressure, blood sodium, blood potassium, plasma renin activity, aldosterone, and ARR between the two groups (P<0.05). There was a significant difference in diagnostic results for PA screening between pre-eluting ARR and post-eluting ARR among patients taking 1-3 antihypertensive agents; however, there was no significant difference among patients taking 4 or more antihypertensive agents (P=0.547). Among the 488 patients included, calcium channel blocker and/or angiotensin converting enzyme inhibitors / angiotensin receptor interceptor were the most used antihypertensive regimen. ARR≥23.6(ng/dL)/[ng/(mL·h)] could be used as the cut-off point of ARR screening PA before elution. Conclusions When PA screening is performed in patients with hypertension, it can be directly screened for patients taking 4 or more antihypertensive drugs. As to patients taking 1-3 antihypertensive drugs, such as calcium channel blocker and/or angiotensin converting enzyme inhibitors / angiotensin receptor interceptor, ARR≥23.6 (ng/dL)/[ng/(mL·h)] can be selected as the cut-off value.

Citation： WU Xi, ZHAO Lianling, REN Yan, TIAN Haoming, CHEN Tao. A real-world study on the impact of antihypertensive drugs on screening tests for primary aldosteronism. West China Medical Journal, 2025, 40(5): 755-760. doi: 10.7507/1002-0179.202310038 Copy

1.	Tomaschitz A, Pilz S. Aldosterone to renin ratio--a reliable screening tool for primary aldosteronism?. Horm Metab Res, 2010, 42(6): 382-391.
2.	K?yser SC, Dekkers T, Groenewoud HJ, et al. Study heterogeneity and estimation of prevalence of primary aldosteronism: a systematic review and meta-regression analysis. J Clin Endocrinol Metab, 2016, 101(7): 2826-2835.
3.	Monticone S, D’Ascenzo F, Moretti C, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol, 2018, 6(1): 41-50.
4.	Dunn PJ, Espiner EA. Outpatient screening tests for primary aldosteronism. Aust N Z J Med, 1976, 6(2): 131-135.
5.	Hiramatsu K, Yamada T, Yukimura Y, et al. A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Results in hypertensive patients. Arch Intern Med, 1981, 141(12): 1589-1593.
6.	Funder JW, Carey RM, Fardella C, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008, 93(9): 3266-3281.
7.	Alnazer RM, Veldhuizen GP, Kroon AA, et al. The effect of medication on the aldosterone-to-renin ratio. A critical review of the literature. J Clin Hypertens (Greenwich), 2021, 23(2): 208-214.
8.	中華醫學會內分泌學分會. 原發性醛固酮增多癥診斷治療的專家共識(2020 版). 中華內分泌代謝雜志, 2020, 36(9): 727-736.
9.	Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab, 2016, 101(5): 1889-1916.
10.	Young WF Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med, 2019, 285(2): 126-148.
11.	李元美, 任艷, 陳濤, 等. 原發性醛固酮增多癥診斷與研究進展. 四川大學學報(醫學版), 2020, 51(3): 267-277, 262.
12.	Niizuma S, Nakahama H, Kamide K, et al. The cutoff value of aldosterone-to-renin ratio for the diagnosis of primary aldosteronism in patients taking antihypertensive medicine. Clin Exp Hypertens, 2008, 30(7): 640-647.
13.	馬文君, 婁瑩, 卞瑾, 等. 洗脫前醛固酮/腎素濃度比值在原發性醛固酮增多癥篩查中的應用. 中華醫學雜志, 2020, 100(41): 3250-3254.
14.	唐佳, 陳濤, 譚璐, 等. 采用化學發光法測定的立位醛固酮與腎素比值篩查四川省高血壓人群中原發性醛固酮增多癥的切點. 中華高血壓雜志, 2023, 31(3): 241-246.
15.	Fischer E, Beuschlein F, Bidlingmaier M, et al. Commentary on the endocrine society practice guidelines: consequences of adjustment of antihypertensive medication in screening of primary aldosteronism. Rev Endocr Metab Disord, 2011, 12(1): 43-48.
16.	Volpe C, Wahrenberg H, Hamberger B, et al. Screening for primary aldosteronism in a primary care unit. J Renin Angiotensin Aldosterone Syst, 2013, 14(3): 212-219.

1. Tomaschitz A, Pilz S. Aldosterone to renin ratio--a reliable screening tool for primary aldosteronism?. Horm Metab Res, 2010, 42(6): 382-391.
2. K?yser SC, Dekkers T, Groenewoud HJ, et al. Study heterogeneity and estimation of prevalence of primary aldosteronism: a systematic review and meta-regression analysis. J Clin Endocrinol Metab, 2016, 101(7): 2826-2835.
3. Monticone S, D’Ascenzo F, Moretti C, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol, 2018, 6(1): 41-50.
4. Dunn PJ, Espiner EA. Outpatient screening tests for primary aldosteronism. Aust N Z J Med, 1976, 6(2): 131-135.
5. Hiramatsu K, Yamada T, Yukimura Y, et al. A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Results in hypertensive patients. Arch Intern Med, 1981, 141(12): 1589-1593.
6. Funder JW, Carey RM, Fardella C, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008, 93(9): 3266-3281.
7. Alnazer RM, Veldhuizen GP, Kroon AA, et al. The effect of medication on the aldosterone-to-renin ratio. A critical review of the literature. J Clin Hypertens (Greenwich), 2021, 23(2): 208-214.
8. 中華醫學會內分泌學分會. 原發性醛固酮增多癥診斷治療的專家共識(2020 版). 中華內分泌代謝雜志, 2020, 36(9): 727-736.
9. Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab, 2016, 101(5): 1889-1916.
10. Young WF Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med, 2019, 285(2): 126-148.
11. 李元美, 任艷, 陳濤, 等. 原發性醛固酮增多癥診斷與研究進展. 四川大學學報(醫學版), 2020, 51(3): 267-277, 262.
12. Niizuma S, Nakahama H, Kamide K, et al. The cutoff value of aldosterone-to-renin ratio for the diagnosis of primary aldosteronism in patients taking antihypertensive medicine. Clin Exp Hypertens, 2008, 30(7): 640-647.
13. 馬文君, 婁瑩, 卞瑾, 等. 洗脫前醛固酮/腎素濃度比值在原發性醛固酮增多癥篩查中的應用. 中華醫學雜志, 2020, 100(41): 3250-3254.
14. 唐佳, 陳濤, 譚璐, 等. 采用化學發光法測定的立位醛固酮與腎素比值篩查四川省高血壓人群中原發性醛固酮增多癥的切點. 中華高血壓雜志, 2023, 31(3): 241-246.
15. Fischer E, Beuschlein F, Bidlingmaier M, et al. Commentary on the endocrine society practice guidelines: consequences of adjustment of antihypertensive medication in screening of primary aldosteronism. Rev Endocr Metab Disord, 2011, 12(1): 43-48.
16. Volpe C, Wahrenberg H, Hamberger B, et al. Screening for primary aldosteronism in a primary care unit. J Renin Angiotensin Aldosterone Syst, 2013, 14(3): 212-219.

West China Medical Journal

A real-world study on the impact of antihypertensive drugs on screening tests for primary aldosteronism

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content