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

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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 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, aldosterone versus renin activity (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 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, ARR with the 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.

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.	Käyser 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.	中华医学会内分泌学分会. 原发性醛固酮增多症诊断治疗的专家共识(2020 版). 中华内分泌代谢杂志, 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, 任艳, 陈涛, 等. 原发性醛固酮增多症诊断与研究进展. 四川大学学报(医学版), 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.	马文君, 娄莹, 卞瑾, 等. 洗脱前醛固酮/肾素浓度比值在原发性醛固酮增多症筛查中的应用. 中华医学杂志, 2020, 100(41): 3250-3254.
14.	唐佳, 陈涛, 谭璐, 等. 采用化学发光法测定的立位醛固酮与肾素比值筛查四川省高血压人群中原发性醛固酮增多症的切点. 中华高血压杂志, 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. Käyser 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. 中华医学会内分泌学分会. 原发性醛固酮增多症诊断治疗的专家共识(2020 版). 中华内分泌代谢杂志, 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, 任艳, 陈涛, 等. 原发性醛固酮增多症诊断与研究进展. 四川大学学报(医学版), 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. 马文君, 娄莹, 卞瑾, 等. 洗脱前醛固酮/肾素浓度比值在原发性醛固酮增多症筛查中的应用. 中华医学杂志, 2020, 100(41): 3250-3254.
14. 唐佳, 陈涛, 谭璐, 等. 采用化学发光法测定的立位醛固酮与肾素比值筛查四川省高血压人群中原发性醛固酮增多症的切点. 中华高血压杂志, 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.

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