Effects of Mineralocorticoid and AT1 Receptor Antagonism on The Aldosterone-Renin Ratio In Primary Aldosteronism—the EMIRA Study
- 18 February 2020
- journal article
- research article
- Published by The Endocrine Society in Journal of Clinical Endocrinology & Metabolism
- Vol. 105 (6), 2060-2067
- https://doi.org/10.1210/clinem/dgaa080
Abstract
Context The withdrawal of mineralocorticoid-receptor antagonist (MRA) and renin-angiotensin system blockers recommended in current guidelines for case detection of primary aldosteronism (PA) can worsen hypokalemia and control of high blood pressure (BP) values. Objective To investigate if aldosterone/renin ratio (ARR) values were affected by the MRA canrenone and/or by canrenone plus olmesartan treatment in patients with PA. Design Within-patient study. Setting The European Society of Hypertension center of excellence at the University of Padua. Patients Consecutive patients with an unambiguous diagnosis of PA subtyped by adrenal vein sampling (AVS). Interventions Patients were treated for one-month treatment with canrenone (50-100 mg orally), and a further month with canrenone plus olmesartan (10-20 mg orally). Canrenone and olmesartan were up-titrated over the first two weeks until BP values and hypokalemia were controlled. Patients with unilateral PA were adrenalectomized; those with bilateral PA were treated medically. Main Outcome Measures BP, plasma levels of sodium and potassium, renin, and aldosterone. Results Canrenone neither lowered plasma aldosterone nor did raise renin, thus leaving the high ARR and true positive rate unaffected. Addition of the angiotensin type 1 receptor blocker raised renin and slightly lowered aldosterone, thus reducing the ARR and increasing the false negative rate. Conclusions At doses that effectively controlled serum potassium and BP values, canrenone did not preclude an accurate diagnosis in patients with PA. Addition of the angiotensin type 1 receptor blocker olmesartan slightly raised the false negative rate. Hence, MRA did not seem to endanger the accuracy of the diagnosis of PA.Keywords
Funding Information
- Italian Ministry of Health (RF2011-02352318)
- University of Padova (DOR1625891/16, DOR1670784/16, BIRD163255/16)
This publication has 32 references indexed in Scilit:
- Prospective validation of an automated chemiluminescence-based assay of renin and aldosterone for the work-up of arterial hypertensioncclm, 2016
- The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice GuidelineJournal of Clinical Endocrinology & Metabolism, 2016
- Non‐steroidal mineralocorticoid receptor antagonism for the treatment of cardiovascular and renal diseaseEuropean Journal of Heart Failure, 2015
- Adrenal Histopathology in Primary AldosteronismHypertension, 2015
- Outcome of Adrenal Vein Sampling Performed During Concurrent Mineralocorticoid Receptor Antagonist TherapyJournal of Clinical Endocrinology & Metabolism, 2014
- An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary AldosteronismHypertension, 2014
- Primary aldosteronism: emerging trendsTrends in Endocrinology & Metabolism, 2013
- Effect of Atenolol on Aldosterone/Renin Ratio Calculated by Both Plasma Renin Activity and Direct Renin Concentration in Healthy Male VolunteersJournal of Clinical Endocrinology & Metabolism, 2010
- A Prospective Study of the Prevalence of Primary Aldosteronism in 1,125 Hypertensive PatientsJournal of the American College of Cardiology, 2006
- Toward Complete and Accurate Reporting of Studies of Diagnostic AccuracyAmerican Journal of Clinical Pathology, 2003