Download PDF
Exp Clin Endocrinol Diabetes 2012; 120(07): 388-394
DOI: 10.1055/s-0032-1301894
Article
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

One-hour Upright Posture is an Ideal Position for Serum Aldosterone Concentration and Plasma Renin Activity Measuring on Primary Aldosteronism Screening

G. Yin
1   Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
,
S. Zhang
2   Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
L. Yan
2   Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
M. Wu
2   Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
M. Xu
2   Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
F. Li
2   Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
H. Cheng
2   Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
› Author Affiliations
Further Information

Publication History

received 15 June 2011
first decision 04 January 2012

accepted 18 January 2012

Publication Date:
11 June 2012 (online)

Also available at
    Permissions and Reprints

Abstract

Objective:

The serum aldosterone concentration (SAC) to plasma renin activity (PRA) ratio (ARR) is considered a useful screening test in the differential diagnosis of essential hypertension (EH) and primary aldosteronism (PA). The purpose of this study is to investigate the variation of ARR and compare the screening efficiency of it under different postures.

Design:

37 patients with PA and 92 patients with EH were recruited in this study. Blood was sampled for measuring SAC and PRA under conditions of overnight recumbency, keeping upright posture for 1 h, 2 h and 4 h. The variation and screening efficiency of ARR under these conditions were compared according to repeated measured ANOVA and ROC curve analysis.

Results:

In the EH group, ARR measured under recumbency posture was higher than those measured under keeping upright posture for 1 h and 2 h. In the PA group, there is no statistical difference for ARR between any 2 postures. AUCs of ARR measured under 4 conditions were 0.976, 0.995, 0.988, and 0.974 respectively. Cutoff values were ranging from 24.75 ng/dl per ng/ml/h under keeping upright for 2 h to 69.19 ng/dl per ng/ml/h under overnight recumbercy. ARR measured under keeping upright posture for 1 h produced the best characteristic of screening efficiency.

Conclusion:

Keeping upright posture for 1 h was the ideal position for ARR measuring and using a cutoff value of 35.90 ng/dl per ng/ml/h will have a sensitivity and specificity of 100.00% and 92.30% respectively.

Key words

aldosterone - aldosterone/plasma renin activity ratio - plasma renin activity - primary aldosteronism
 

  • References

  • 1 Ahmed AH, Gordon RD, Taylor PJ et al. Effect of contraceptives on aldosterone/renin ratio may vary according to the components of contraceptive, Renin assay method, and possibly route of administration. The Journal of clinical endocrinology and metabolism 2011; 96: 1797-1804
    CrossrefPubMedSearch in Google Scholar
  • 2 Baas SJ, Endert E, Fliers E et al. Establishment of reference values for endocrine tests. III: Primary aldosteronism. The Netherlands journal of medicine 2003; 61: 37-43
    PubMedSearch in Google Scholar
  • 3 Bernini G, Moretti A, Argenio G et al. Primary aldosteronism in normokalemic patients with adrenal incidentalomas. European journal of endocrinology 2002; 146: 523-529
    CrossrefPubMedSearch in Google Scholar
  • 4 Bernini G, Moretti A, Orlandini C et al. Plasma and urine aldosterone to plasma renin activity ratio in the diagnosis of primary aldosteronism. Journal of hypertension 2008; 26: 981-988
    CrossrefPubMedSearch in Google Scholar
  • 5 Calhoun DA, Nishizaka MK, Zaman MA et al. Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension 2002; 40: 892-896
    Search in Google Scholar
  • 6 Fogari R, Preti P, Zoppi A et al. Prevalence of primary aldosteronism among unselected hypertensive patients: a prospective study based on the use of an aldosterone/renin ratio above 25 as a screening test. Hypertension research 2007; 30: 111-117
    CrossrefPubMedSearch in Google Scholar
  • 7 Funder JW, Carey RM, Fardella C et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. The Journal of clinical endocrinology and metabolism 2008; 93: 3266-3281
    CrossrefPubMedSearch in Google Scholar
  • 8 Gallay BJ, Ahmad S, Xu L et al. Screening for primary aldosteronism without discontinuing hypertensive medications: plasma aldosterone-renin ratio. American journal of kidney diseases 2001; 37: 699-705
    CrossrefPubMedSearch in Google Scholar
  • 9 He FJ, Markandu ND, Sagnella GA et al. Importance of the renin system in determining blood pressure fall with salt restriction in black and white hypertensives. Hypertension 1998; 32: 820-824
    CrossrefPubMedSearch in Google Scholar
  • 10 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. Archives of internal medicine 1981; 141: 1589-1593
    CrossrefPubMedSearch in Google Scholar
  • 11 Hirohara D, Nomura K, Okamoto T et al. Performance of the basal aldosterone to renin ratio and of the renin stimulation test by furosemide and upright posture in screening for aldosterone-producing adenoma in low renin hypertensives. The Journal of clinical endocrinology and metabolism 2001; 86: 4292-4298
    CrossrefPubMedSearch in Google Scholar
  • 12 Ito Y, Takeda R, Karashima S et al. Prevalence of primary aldosteronism among prehypertensive and stage 1 hypertensive subjects. Hypertension research 2011; 34: 98-102
    CrossrefPubMedSearch in Google Scholar
  • 13 Kem DC, Weinberger MH, Higgins JR et al. Plasma aldosterone response to ACTH in primary aldosteronism and in patients with low renin hypertension. The Journal of clinical endocrinology and metabolism 1978; 46: 552-560
    CrossrefPubMedSearch in Google Scholar
  • 14 Lamarre-Cliche M, de Champlain J, Lacourciere Y et al. Effects of circadian rhythms, posture, and medication on renin-aldosterone interrelations in essential hypertensives. American journal of hypertension 2005; 18: 56-64
    CrossrefPubMedSearch in Google Scholar
  • 15 Lim PO, Dow E, Brennan G et al. High prevalence of primary aldosteronism in the Tayside hypertension clinic population. Journal of human hypertension 2000; 14: 311-315
    CrossrefPubMedSearch in Google Scholar
  • 16 Loh KC, Koay ES, Khaw MC et al. Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore. The Journal of clinical endocrinology and metabolism 2000; 85: 2854-2859
    CrossrefPubMedSearch in Google Scholar
  • 17 Mosso L, Carvajal C, Gonzalez A et al. Primary aldosteronism and hypertensive disease. Hypertension 2003; 42: 161-165
    Search in Google Scholar
  • 18 Mulatero P, Rabbia F, Milan A et al. Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism. Hypertension 2002; 40: 897-902
    CrossrefPubMedSearch in Google Scholar
  • 19 Mulatero P, Stowasser M, Loh KC et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. The Journal of clinical endocrinology and metabolism 2004; 89: 1045-1050
    CrossrefPubMedSearch in Google Scholar
  • 20 Nwariaku FE, Miller BS, Auchus R et al. Primary hyperaldosteronism: effect of adrenal vein sampling on surgical outcome. Archives of surgery (Chicago, Ill.: 1960) 2006; 141: 497-502; discussion 502–503
    CrossrefPubMedSearch in Google Scholar
  • 21 Olivieri O, Ciacciarelli A, Signorelli D et al. Aldosterone to Renin ratio in a primary care setting: the Bussolengo study. The Journal of clinical endocrinology and metabolism 2004; 89: 4221-4226
    CrossrefPubMedSearch in Google Scholar
  • 22 Omura M, Saito J, Yamaguchi K et al. Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertension research 2004; 27: 193-202
    CrossrefPubMedSearch in Google Scholar
  • 23 Pratt JH, Rebhun JF, Zhou L et al. Levels of mineralocorticoids in whites and blacks. Hypertension 1999; 34: 315-319
    CrossrefPubMedSearch in Google Scholar
  • 24 Rossi GP, Bernini G, Caliumi C et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. Journal of the American College of Cardiology 2006; 48: 2293-2300
    CrossrefPubMedSearch in Google Scholar
  • 25 Sassard J, Vincent M, Annat G et al. A kinetic study of plasma renin and aldosterone during changes of posture in man. The Journal of clinical endocrinology and metabolism 1976; 42: 20-27
    CrossrefPubMedSearch in Google Scholar
  • 26 Schwartz GL, Chapman AB, Boerwinkle E et al. Screening for primary aldosteronism: implications of an increased plasma aldosterone/renin ratio. Clinical chemistry 2002; 48: 1919-1923
    PubMedSearch in Google Scholar
  • 27 Schwartz GL, Turner ST. Screening for primary aldosteronism in essential hypertension: diagnostic accuracy of the ratio of plasma aldosterone concentration to plasma renin activity. Clinical chemistry 2005; 51: 386-394
    CrossrefPubMedSearch in Google Scholar
  • 28 Seifarth C, Trenkel S, Schobel H et al. Influence of antihypertensive medication on aldosterone and renin concentration in the differential diagnosis of essential hypertension and primary aldosteronism. Clinical endocrinology 2002; 57: 457-465
    CrossrefPubMedSearch in Google Scholar
  • 29 Seiler L, Rump LC, Schulte-Monting J et al. Diagnosis of primary aldosteronism: value of different screening parameters and influence of antihypertensive medication. European journal of endocrinology 2004; 150: 329-337
    CrossrefPubMedSearch in Google Scholar
  • 30 Takeda R, Miyamori I, Ikeda M et al. Circadian rhythm of plasma aldosterone and time dependent alterations of aldosterone regulators. Journal of steroid biochemistry 1984; 20: 321-323
    CrossrefPubMedSearch in Google Scholar
  • 31 Tanabe A, Naruse M, Takagi S et al. Variability in the renin/aldosterone profile under random and standardized sampling conditions in primary aldosteronism. The Journal of clinical endocrinology and metabolism 2003; 88: 2489-2494
    CrossrefPubMedSearch in Google Scholar
  • 32 Tiu SC, Choi CH, Shek CC et al. The use of aldosterone-renin ratio as a diagnostic test for primary hyperaldosteronism and its test characteristics under different conditions of blood sampling. The Journal of clinical endocrinology and metabolism 2005; 90: 72-78
    PubMedSearch in Google Scholar
  • 33 Umpierrez GE, Cantey P, Smiley D et al. Primary aldosteronism in diabetic subjects with resistant hypertension. Diabetes care 2007; 30: 1699-1703
    CrossrefPubMedSearch in Google Scholar
  • 34 Unger N, Lopez SI, Pitt C et al. Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in patients with an adrenal mass. European journal of endocrinology 2004; 150: 517-523
    CrossrefPubMedSearch in Google Scholar
  • 35 Young WF, Stanson AW, Thompson GB et al. Role for adrenal venous sampling in primary aldosteronism. Surgery 2004; 136: 1227-1235
    Search in Google Scholar