Gallay B J, Ahmad S, Xu L, Toivola B, Davidson R C
Division of Nephrology, University of California Davis Medical Center, Sacramento, CA, USA.
Am J Kidney Dis. 2001 Apr;37(4):699-705. doi: 10.1016/s0272-6386(01)80117-7.
The traditional workup for primary aldosteronism is cumbersome and requires discontinuing antihypertensive medications, which is inconvenient and potentially dangerous. A simple and accurate screening test that can be used without modifying medications is needed. The plasma aldosterone-renin ratio (ARR) is a valid screening assay for primary aldosteronism, but antihypertensives are usually discontinued before obtaining this ratio, limiting its utility. The present prospective study is designed to examine the validity of the ARR as a screening test for primary aldosteronism if the ratio is measured randomly while patients continue antihypertensive therapy. During the 18-month study period, 90 patients were referred to the hypertension clinic with poorly controlled hypertension. ARR was measured in random blood samples in all 90 patients while maintaining their prescribed antihypertensive medications. Those with elevated ARRs (>100 ng/dL / ng/mL/h) underwent further diagnostic workup, including adrenal computed tomography and/or magnetic resonance imaging and adrenal iodine 131 norcholesterol uptake scan. Fifteen patients (17%) had elevated ARRs greater than 100:1. Ten of 15 patients were found to have adrenal adenoma on diagnostic workup, and adenoma was later confirmed by histological examination after surgical removal in these 10 patients. Five patients were found to have adrenal hyperplasia; all 5 patients responded to antialdosterone treatment. Thus, all 15 patients had good control of blood pressure after surgery and/or antialdosterone medications. No patient showed a falsely elevated ARR. Data suggest that the ARR is a valid screening assay for primary aldosteronism in patients with poorly controlled blood pressure, and discontinuation of antihypertensive medications is not needed for this test.
原发性醛固酮增多症的传统检查方法繁琐，需要停用抗高血压药物，这既不方便又有潜在风险。因此需要一种简单且准确的筛查试验，无需调整药物即可使用。血浆醛固酮-肾素比值（ARR）是原发性醛固酮增多症的有效筛查指标，但通常在获取该比值前需停用抗高血压药物，这限制了其应用。本前瞻性研究旨在探讨在患者继续接受抗高血压治疗时随机测量ARR作为原发性醛固酮增多症筛查试验的有效性。在为期18个月的研究期间，90例血压控制不佳的患者被转诊至高血压门诊。所有90例患者在维持其规定抗高血压药物治疗的同时，采集随机血样测量ARR。ARR升高（>100 ng/dL / ng/mL/h）的患者接受进一步诊断检查，包括肾上腺计算机断层扫描和/或磁共振成像以及肾上腺碘131胆固醇摄取扫描。15例患者（17%）的ARR大于100:1。15例患者中有10例在诊断检查中发现肾上腺腺瘤，这10例患者术后经组织学检查证实为腺瘤。5例患者发现肾上腺增生；所有5例患者对抗醛固酮治疗有反应。因此，所有15例患者在手术和/或使用抗醛固酮药物后血压得到良好控制。没有患者出现ARR假阳性升高。数据表明，ARR是血压控制不佳患者原发性醛固酮增多症的有效筛查指标，进行该检测无需停用抗高血压药物。
