Diagnostic evaluation of plasma aldosterone concentration to plasma renin activity ratio in primary aldosteronism

Abstract

Using the plasma aldosterone concentration to plasma renin activity ratio (PAC/PRA ratio) as the screening test of choice for primary aldosteronism in hypertensive patients, we studied the clinical characteristics and the diagnostic value of PAC/PRA ratio in primary aldosteronism. The plasma aldosterone concentration (PAC) and plasma renin activity (PRA) levels were measured by radioimmunoassay in 902 hypertensive patients from out-patient clinics or hospitals. One hundred and twenty-six suspected primary aldosteronism patients whose PAC/PRA ratio was > 25 ng/dL/ng/mL/hr had a lamellar computed tomography (CT) scan in the adrenal gland and follow-up visits. The proportion of primary aldosteronism in hypertensive patients was 14% (126/902). There were 54 patients with unilateral or bilateral hyperplasia and 25 patients with adenoma according to the CT scan. 39% (49/126) of the patients with primary aldosteronism had hypokalemia. Twenty-five patients received surgical treatment. The efficacy and cure rates were 100% (25/25) and 48% (12/25), respectively. The effective rate of aldactone and the single-drug cure rate were 89% (48/54) and 24% (13/54), respectively. Primary aldosteronism affects over 10% of hypertensive patients in China. The PAC/PRA ratio can be considered as a routine screening test in hypertensives, especially resistant hypertensive patients and a high PAC/PRA ratio is an invaluable index in primary aldosteronism diagnosis.

References

1. Conn J W PrimaryaldosteronismJ Lab Clin Med 1955 45(4)661664
2. Stowasser M Primaryaldosteronism: revival of a syndromeJ Hypertens 2001 1993(3)363366
3. Nishizaka M K Calhoun D A The role of aldosterone antagonistsin the management of resistant hypertensionCurr Hypertens Rep 2005 7(5)343347
4. Gordon R D Primaryaldosteronism-actual epidemics or false alarm?Arq Bras Endocrinol Metabol 2004 48(5)666673
5. Hiramatsu K Yamada T Yukimura Y Komiya I Ichikawa K Ishihara M Nagata H Izumiyama T A screening test to identify aldosterone-producing adenomaby measuring plasma renin activity. Results in hypertensive patients. Arch Intern Med 1981 141(12)15891593
6. Stowasser M Gordon R D Gunasekera T G Cowley D C Ward G Archibald C Smithers B M High rate of detection of primaryaldosteronism, including surgically treatable forms, after ‘non-selective'screening of hypertensive patientsHypertension 2003 21(11)21492157
7. Young W F J r Minireview: Primary aldosteronism-changing concepts in diagnosisand treatmentEndocrinology 2003 144(6)22082213
8. Calhoun D A Nishizaka M K Zaman M A Thakkar R B Weissmann P Hyperaldosteronism among black and whitesubjects with resistant hypertensionHypertension 2002 40(6)892896
9. Montori V M Young W F J r Use of plasma aldosterone concentration-to-plasmarenin activity ratio as a screening test for primary aldosteronism:A systematic review of the literatureEndocrinolMetab Clin North Am 2002 31(3)619632
10. Nishizaka M K Zaman M A Calhoun D A Efficacy of Low-Dose Spironolactone in Subjects With ResistantHypertensionAm J Hypertens 2003 16(11 Pt 1)925930
11. Funder J W Editorial:aldosterone, normotension, and diastolic dysfunctionJ Clin Endocrinol Metab 2005 90(9)55005501
12. Bovy C Delanaye P Radermecker R P Hamoir E Maweja S Krzesinski J M Hypertensiondue to primary aldosteronismRev Med Liege 2005 60(4)255263
13. Sasano H Suzuki T Moriya T Pathology of primary aldosteronismNippon Rinsho 2005 63(Suppl 3)283287
14. Nishizaka M K Calhoun D A Primary aldosteronism: diagnosticand therapeutic considerationsCurr CardiolRep 2005 7(6)412417
15. Nishizaka M K Calhoun D A The role of aldosterone antagonistsin the management of resistant hypertensionCurr Hypertens Rep 2005 7(5)343347