Rene Baudrand1, Francisco J Guarda1, Jasmine Torrey1, Gordon Williams1, Anand Vaidya1. 1. Program for Adrenal Disorders and Endocrine Hypertension (R.B., F.J.G.), Department of Endocrinology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago 7550006, Chile; and Center for Adrenal Disorders (J.T., G.W., A.V.), Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Abstract
CONTEXT: The aldosterone to renin ratio (ARR) is recommended to screen for primary aldosteronism (PA). OBJECTIVE: To evaluate whether dietary sodium restriction results in misinterpretation of PA screening. PARTICIPANTS: Untreated hypertensives with ARR more than 20 on a high dietary sodium intake (HS) were also evaluated on a low dietary sodium intake (LS) (n = 241). Positive screening for PA was defined as: plasma renin activity (PRA) less than or equal to 1.0 ng/mL · h with serum aldosterone more than or equal to 6 ng/dL. PA was confirmed by a 24-hour urinary aldosterone excretion more than or equal to 12 mcg with urinary sodium more than 200 mmol. RESULTS: Only 33% (79/241) of participants with an ARR more than 20 had a positive PA screen on HS. On LS, 56% (44/79) of these participants no longer met criteria for positive PA screening. When compared with participants with positive PA screening on both diets, participants with a positive screen on HS but negative on LS exhibited a significantly higher PRA on both diets. Remarkably, of the 48/79 participants who had PA confirmed, 52% had negative PA screening on LS. The distinguishing feature of these participants with "discordant" screening results was a larger rise in PRA on LS resulting in normalization of the ARR and higher Caucasian race prevalence. CONCLUSIONS: Sodium restriction is recommended in hypertension; however, it can significantly raise PRA, normalize the ARR, and result in false interpretation of PA screening. Milder phenotypes of PA, where PRA is not as suppressed, are most susceptible to dietary sodium influences on renin and ARR. Optimal screening for PA should occur under conditions of HS.
CONTEXT: The aldosterone to renin ratio (ARR) is recommended to screen for primary aldosteronism (PA). OBJECTIVE: To evaluate whether dietary sodium restriction results in misinterpretation of PA screening. PARTICIPANTS: Untreated hypertensives with ARR more than 20 on a high dietary sodium intake (HS) were also evaluated on a low dietary sodium intake (LS) (n = 241). Positive screening for PA was defined as: plasma renin activity (PRA) less than or equal to 1.0 ng/mL · h with serum aldosterone more than or equal to 6 ng/dL. PA was confirmed by a 24-hour urinary aldosterone excretion more than or equal to 12 mcg with urinary sodium more than 200 mmol. RESULTS: Only 33% (79/241) of participants with an ARR more than 20 had a positive PA screen on HS. On LS, 56% (44/79) of these participants no longer met criteria for positive PA screening. When compared with participants with positive PA screening on both diets, participants with a positive screen on HS but negative on LS exhibited a significantly higher PRA on both diets. Remarkably, of the 48/79 participants who had PA confirmed, 52% had negative PA screening on LS. The distinguishing feature of these participants with "discordant" screening results was a larger rise in PRA on LS resulting in normalization of the ARR and higher Caucasian race prevalence. CONCLUSIONS: Sodium restriction is recommended in hypertension; however, it can significantly raise PRA, normalize the ARR, and result in false interpretation of PA screening. Milder phenotypes of PA, where PRA is not as suppressed, are most susceptible to dietary sodium influences on renin and ARR. Optimal screening for PA should occur under conditions of HS.
Authors: Joshua E Raizman; Eleftherios P Diamandis; Daniel Holmes; Michael Stowasser; Richard Auchus; Etienne Cavalier Journal: Clin Chem Date: 2015-06-23 Impact factor: 8.327
Authors: Elliott M Antman; Lawrence J Appel; Douglas Balentine; Rachel K Johnson; Lyn M Steffen; Emily Ann Miller; Antigoni Pappas; Kimberly F Stitzel; Dorothea K Vafiadis; Laurie Whitsel Journal: Circulation Date: 2014-05-05 Impact factor: 29.690
Authors: Christopher Newton-Cheh; Chao-Yu Guo; Philimon Gona; Martin G Larson; Emelia J Benjamin; Thomas J Wang; Sekar Kathiresan; Christopher J O'Donnell; Stacy L Musone; Amy L Camargo; Jared A Drake; Daniel Levy; Joel N Hirschhorn; Ramachandran S Vasan Journal: Hypertension Date: 2007-02-12 Impact factor: 10.190
Authors: Eduardo Pimenta; Michael Stowasser; Richard D Gordon; Susan M Harding; Michel Batlouni; Bin Zhang; Suzanne Oparil; David A Calhoun Journal: Chest Date: 2013-04 Impact factor: 9.410
Authors: Anand Vaidya; Patricia C Underwood; Paul N Hopkins; Xavier Jeunemaitre; Claudio Ferri; Gordon H Williams; Gail K Adler Journal: Hypertension Date: 2013-02-11 Impact factor: 10.190