ArticleThe Journal of clinical endocrinology and metabolism2016
Dietary Sodium Restriction Increases the Risk of Misinterpreting Mild Cases of Primary Aldosteronism.
Article in The Journal of clinical endocrinology and metabolism, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
42 citing papers in PubMed, 1 synthesis or guideline pooled it, 73 citations in OpenAlex.
- A low dietary sodium dose is associated with a more pronounced aldosterone response in normotensive than in hypertensive individuals.Scientific reports · 2023Pooled it
- Dietary Sodium Reduction Reveals Aldosterone Dysregulation in Patients With Essential Hypertension.Journal of clinical hypertension (Greenwich, Conn.) · 2026Trial
- The amount of sodium intake may affect the susceptibility to treatment with mineralocorticoid receptor antagonists in patients with primary aldosteronism.Clinical and experimental nephrology · 2026Article
- Low-renin hypertension in incidental adrenal adenomas and response to aldosterone-targeted therapy: a prospective study.European journal of internal medicine · 2026Article
- Primary aldosteronism.Nature reviews. Disease primers · 2026Review
- Renin-aldosterone testing: The essentials.Clinical medicine (London, England) · 2026Review
- Aldosterone fuels the progression of cardiovascular-kidney -metabolic syndrome: focus on primary aldosteronism spectrum.Endocrine · 2026Review
- Incidence of Adrenal Masses Eventually Discovered in Patients Screened for Primary Aldosteronism.The Journal of clinical endocrinology and metabolism · 2026Article
- Primary aldosteronism with postoperative elevation of aldosterone treated effectively by finerenone: A case report.Journal of clinical hypertension (Greenwich, Conn.) · 2024Article
- Treating Primary Aldosteronism-Induced Hypertension: Novel Approaches and Future Outlooks.Endocrine reviews · 2024Article
- Biomarkers to Guide Medical Therapy in Primary Aldosteronism.Endocrine reviews · 2024Review
- Renin as a Biomarker to Guide Medical Treatment in Primary Aldosteronism Patients. Findings from the SPAIN-ALDO Registry.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2024Article
- Shifting paradigms in primary aldosteronism: reconsideration of screening strategy via integrating pathophysiological insights.Frontiers in endocrinology · 2024Review
- Association of Aldosterone, Renin, and Aldosterone to Renin Ratio with Metabolic Profile in Primary Aldosteronism.Diabetes, metabolic syndrome and obesity : targets and therapy · 2024Article
- Primary Aldosteronism: State-of-the-Art Review.American journal of hypertension · 2022Article
- Coexistence of Renin-independent Aldosterone Secretion and Multiple Endocrine Neoplasia Type 1 Within a Family.Journal of the Endocrine Society · 2022Article
- Characteristics of aldosterone-producing adenomas in patients without plasma renin activity suppression.PloS one · 2022Article
- Approach to the Patient with an Incidental Adrenal Mass.The Medical clinics of North America · 2021Review
- Primary Aldosteronism: a Continuum from Normotension to Hypertension.Current cardiology reports · 2021Review
- Therapeutic Outcomes with Surgical and Medical Management of Primary Aldosteronism.Current cardiology reports · 2021Review
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
Abstract
contextThe aldosterone to renin ratio (ARR) is recommended to screen for primary aldosteronism (PA).
objectiveTo evaluate whether dietary sodium restriction results in misinterpretation of PA screening.
participantsUntreated 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.
resultsOnly 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.
conclusionsSodium 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.
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