ArticleEndocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists2020
Mineralocorticoid Receptor Antagonists Decrease the Rates of Positive Screening for Primary Aldosteronism.
Article in Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 19 citations in OpenAlex.
- Primary aldosteronism.Nature reviews. Disease primers · 2026Review
- Interplay Between the Mineralocorticoid System, Inflammation, Hypertension, and Kidney Disease.Kidney360 · 2025Review
- Feasibility of primary aldosteronism diagnosis in initial evaluation without medication withdrawal or confirmatory tests.Endocrine · 2024Article
- Challenges in Diagnosing and Managing the Spectrum of Primary Aldosteronism.Journal of the Endocrine Society · 2024Article
- Article
- Practical recommendations for antihypertensive therapy during the primary aldosteronism screening test.Endocrine · 2024Article
- Primary aldosteronism - a multidimensional syndrome.Nature reviews. Endocrinology · 2022Review
- Article
- High Prevalence of Autonomous Aldosterone Production in Hypertension: How to Identify and Treat It.Current hypertension reports · 2022Review
- Primary Aldosteronism: a Continuum from Normotension to Hypertension.Current cardiology reports · 2021Review
- Recent Development toward the Next Clinical Practice of Primary Aldosteronism: A Literature Review.Biomedicines · 2021Review
- In Silico Analysis of the Gene Expression Patterns between Aldosterone-Producing Adenoma and Nonfunctional Adrenocortical Adenoma.Genetics research · 2021Article
- The Effect of Antihypertensive Medications on Testing for Primary Aldosteronism.Frontiers in pharmacology · 2021Review
- MANAGEMENT OF ENDOCRINE DISEASE: The role of surgical adrenalectomy in primary aldosteronism.European journal of endocrinology · 2020Review
- Aldosterone Levels Post-IV Saline Suppression Using Commercial Reference Laboratory Liquid Chromatography-Tandem Mass Spectrometry Assay.AACE endocrinology and diabetesArticle
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Authors and funding
2 authors at 2 institutions in 2 countries.
Funding
Abstract
objectiveMineralocorticoid receptor antagonists (MRAs) are effective in patients with resistant hypertension and/or primary aldosteronism (PA). Screening for PA should ideally be conducted after stopping medications that might interfere with the renin-angiotensin-aldosterone system, but this is challenging in patients with recalcitrant hypertension or hypokalemia. Herein, we aimed to evaluate the impact of MRAs on PA screening in clinical practice.
methodsWe conducted a retrospective cohort study of patients with hypertension who had plasma aldosterone and renin measurements before and after MRA use in a tertiary referral center, over 19 years.
resultsA total of 146 patients, 91 with PA, were included and followed for up to 18 months. Overall, both plasma renin and aldosterone increased after MRA initiation (from median, interquartile range: 0.5 [0.1, 0.8] to 1.2 [0.6, 4.8] ng/mL/hour and from 19.1 [12.9, 27.7] to 26.4 [17.1, 42.3] ng/dL, respectively; P<.0001 for both), while the aldosterone/renin ratio (ARR) decreased from 40.3 (18.5, 102.7) to 23.1 (8.6, 58.7) ng/dL per ng/mL/hour (P<.0001). Similar changes occurred irrespective of the MRA treatment duration and other antihypertensives used. Positive PA screening abrogation after MRA initiation was found in 45/94 (48%) patients. Conversely, 17% of patients had positive PA screening only after MRA treatment, mostly due to correction of hypokalemia. An initially positive screening test was more likely altered by high MRA doses and more likely persistent in patients with confirmed PA or taking beta-blockers.
conclusionMRAs commonly reduce ARR and the proportion of positive PA screening results. When PA is suspected, screening should be repeated off MRAs. ABBREVIATIONS: ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; ARR = aldosterone/renin ratio; DRC = direct renin concentration; MRA = mineralocorticoid receptor antagonist; PA = primary aldosteronism; PAC = plasma aldosterone concentration; PRA = plasma renin activity; RAAS = renin-angiotensin-aldosterone system.
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