Abstract
The serum aldosterone concentration (SAC)/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 effect of age on ARR and compare the screening accuracy of ARR plus elevated SAC for PA screening in different age groups. Thirty-nine patients with PA, 274 patients with EH, and 153 healthy volunteers were recruited. Blood was sampled for SAC and PRA measuring under keeping upright posture for 1 h. Levels of SAC, PRA, and ARR were compared at different ages range for the respective three groups of subjects. The screening accuracy of ARR plus elevated SAC was compared in different age groups and PA patients served as the same positive subjects. In the EH group, logarithmically transformed ARR (Log-ARR) increased with advancing age and reached its peak in the ≥60 years group; in the normotensives group, Log-ARR reached its peak in the 40–49 years group and slightly declined with advancing age. In the PA group, Log-ARR was not age dependent. Screening accuracy increased when combined index of ARR and SAC was used in the ≥40 years group but not in the <40 years group. Although the number of EH patients with elevated ARR increased with advancing age, but the screening accuracy and cutoff values of ARR were not affected by age. Using the combined index of ARR and SAC increased the screening accuracy for the patients older than 40 years, but not necessary for the patients younger than 40 years.
Similar content being viewed by others
References
G. Bernini, A. Moretti, G. Argenio, A. Salvetti, Primary aldosteronism in normokalemic patients with adrenal incidentalomas. Eur. J. Endocrinol. 146, 523–529 (2002)
D.A. Calhoun, M.K. Nishizaka, M.A. Zaman, R.B. Thakkar, P. Weissmann, Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension 40, 892–896 (2002)
P. Mulatero, F. Rabbia, A. Milan, C. Paglieri, F. Morello, L. Chiandussi, F. Veglio, Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism. Hypertension 40, 897–902 (2002)
L. Mosso, C. Carvajal, A. Gonzalez, A. Barraza, F. Avila, J. Montero, A. Huete, A. Gederlini, C.E. Fardella, Primary aldosteronism and hypertensive disease. Hypertension 42, 161–165 (2003)
P. Mulatero, M. Stowasser, K.C. Loh, C.E. Fardella, R.D. Gordon, L. Mosso, C.E. Gomez-Sanchez, F. Veglio, W.F. Young Jr, Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J. Clin. Endocrinol. Metab. 89, 1045–1050 (2004)
O. Olivieri, A. Ciacciarelli, D. Signorelli, F. Pizzolo, P. Guarini, C. Pavan, A. Corgnati, S. Falcone, R. Corrocher, A. Micchi, C. Cressoni, G. Blengio, Aldosterone to Renin ratio in a primary care setting: the Bussolengo study. J. Clin. Endocrinol. Metab. 89, 4221–4226 (2004)
M. Omura, J. Saito, K. Yamaguchi, Y. Kakuta, T. Nishikawa, Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens. Res. 27, 193–202 (2004)
G.P. Rossi, G. Bernini, C. Caliumi, G. Desideri, B. Fabris, C. Ferri, C. Ganzaroli, G. Giacchetti, C. Letizia, M. Maccario, F. Mallamaci, M. Mannelli, M.J. Mattarello, A. Moretti, G. Palumbo, G. Parenti, E. Porteri, A. Semplicini, D. Rizzoni, E. Rossi, M. Boscaro, A.C. Pessina, F. Mantero, A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J. Am. Coll. Cardiol. 48, 2293–2300 (2006)
R. Fogari, P. Preti, A. Zoppi, A. Rinaldi, E. Fogari, A. Mugellini, 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. Hypertens. Res. 30, 111–117 (2007)
G.E. Umpierrez, P. Cantey, D. Smiley, A. Palacio, D. Temponi, K. Luster, A. Chapman, Primary aldosteronism in diabetic subjects with resistant hypertension. Diabetes Care 30, 1699–1703 (2007)
Y. Ito, R. Takeda, S. Karashima, Y. Yamamoto, T. Yoneda, Y. Takeda, Prevalence of primary aldosteronism among prehypertensive and stage 1 hypertensive subjects. Hypertens. Res. 34, 98–102 (2011)
J.W. Funder, R.M. Carey, C. Fardella, C.E. Gomez-Sanchez, F. Mantero, M. Stowasser, W.F. Young Jr, V.M. Montori, Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 93, 3266–3281 (2008)
Sukor N, Primary aldosteronism: from bench to bedside. Endocrine (2011). doi:10.1007/s12020-011-9553-3
A. Tanabe, M. Naruse, S. Takagi, K. Tsuchiya, T. Imaki, K. Takano, Variability in the renin/aldosterone profile under random and standardized sampling conditions in primary aldosteronism. J. Clin. Endocrinol. Metab. 88, 2489–2494 (2003)
L. Seiler, L.C. Rump, J. Schulte-Monting, M. Slawik, K. Borm, H. Pavenstadt, F. Beuschlein, M. Reincke, Diagnosis of primary aldosteronism: value of different screening parameters and influence of antihypertensive medication. Eur. J. Endocrinol. 150, 329–337 (2004)
S.C. Tiu, C.H. Choi, C.C. Shek, Y.W. Ng, F.K. Chan, C.M. Ng, A.P. Kong, The use of aldosterone-renin ratio as a diagnostic test for primary hyperaldosteronism and its test characteristics under different conditions of blood sampling. J. Clin. Endocrinol. Metab. 90, 72–78 (2005)
J.L. Zozaya, M.P. Viloria, A. Castro, The effect of age on the renin-angiotensin-aldosterone systems and other physiological variables in normal subjects. Res. Commun. Chem. Pathol. Pharmacol. 42, 463–470 (1983)
K. Tsunoda, K. Abe, T. Goto, M. Yasujima, M. Sato, K. Omata, M. Seino, K. Yoshinaga, Effect of age on the renin-angiotensin-aldosterone system in normal subjects: simultaneous measurement of active and inactive renin, renin substrate, and aldosterone in plasma. J. Clin. Endocrinol. Metab. 62, 384–389 (1986)
W.F. Young, Primary aldosteronism: renaissance of a syndrome. Clin. Endocrinol. 66, 607–618 (2007)
O.L. Castro, X. Yu, D.C. Kem, Diagnostic value of the post-captopril test in primary aldosteronism. Hypertension 39, 935–938 (2002)
G. Giacchetti, V. Ronconi, F. Turchi, L. Agostinelli, F. Mantero, S. Rilli, M. Boscaro, Aldosterone as a key mediator of the cardiometabolic syndrome in primary aldosteronism: an observational study. J. Hypertens. 25, 177–186 (2007)
K. Hiramatsu, T. Yamada, Y. Yukimura, I. Komiya, K. Ichikawa, M. Ishihara, H. Nagata, T. Izumiyama, A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Results in hypertensive patients. Arch. Intern. Med. 141, 1589–1593 (1981)
S.J. Baas, E. Endert, E. Fliers, M.F. Prummel, W.M. Wiersinga, Establishment of reference values for endocrine tests. III: primary aldosteronism. Neth. J. Med. 61, 37–43 (2003)
M. Lamarre-Cliche, J. de Champlain, Y. Lacourciere, L. Poirier, M. Karas, P. Larochelle, Effects of circadian rhythms, posture, and medication on renin-aldosterone interrelations in essential hypertensives. Am. J. Hypertens. 18, 56–64 (2005)
F.J. He, N.D. Markandu, G.A. Sagnella, G.A. MacGregor, Importance of the renin system in determining blood pressure fall with salt restriction in black and white hypertensives. Hypertension 32, 820–824 (1998)
C. Seifarth, S. Trenkel, H. Schobel, E.G. Hahn, J. Hensen, Influence of antihypertensive medication on aldosterone and renin concentration in the differential diagnosis of essential hypertension and primary aldosteronism. Clin. Endocrinol. 57, 457–465 (2002)
A.H. Ahmed, R.D. Gordon, P.J. Taylor, G. Ward, E. Pimenta, M. Stowasser, Effect of contraceptives on aldosterone/renin ratio may vary according to the components of contraceptive, Renin assay method, and possibly route of administration. J. Clin. Endocrinol. Metab. 96, 1797–1804 (2011)
N. Unger, S.I. Lopez, C. Pitt, M.K. Walz, T. Philipp, K. Mann, S. Petersenn, Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in patients with an adrenal mass. Eur. J. Endocrinol. 150, 517–523 (2004)
C. Newton-Cheh, C.Y. Guo, P. Gona, M.G. Larson, E.J. Benjamin, T.J. Wang, S. Kathiresan, C.J. O’Donnell, S.L. Musone, A.L. Camargo, J.A. Drake, D. Levy, J.N. Hirschhorn, R.S. Vasan, Clinical and genetic correlates of aldosterone-to-renin ratio and relations to blood pressure in a community sample. Hypertension 49, 846–856 (2007)
G. Bernini, A. Moretti, C. Orlandini, P. Berti, P. Miccoli, M. Bardini, C. Taurino, M. Bernini, A. Salvetti, Plasma and urine aldosterone to plasma renin activity ratio in the diagnosis of primary aldosteronism. J. Hypertens. 26, 981–988 (2008)
A. Hannemann, N. Friedrich, J. Ludemann, H. Volzke, R. Rettig, J. Peters, M. Reincke, A. Doring, M. Nauck, H. Wallaschofski, Reference intervals for aldosterone, renin, and the aldosterone-to-renin ratio in the population-based Study of Health in Pomerania (SHIP-1). Horm. Metab. Res. 42, 392–399 (2010)
K.C. Loh, E.S. Koay, M.C. Khaw, S.C. Emmanuel, W.F. Young Jr, Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore. J. Clin. Endocrinol. Metab. 85, 2854–2859 (2000)
C.E. Kater, E.G. Biglieri, The syndromes of low-renin hypertension: “separating the wheat from the chaff”. Arq. Bras. Endocrinol. Metabol. 48, 674–681 (2004)
G.L. Schwartz, S.T. Turner, Screening for primary aldosteronism in essential hypertension: diagnostic accuracy of the ratio of plasma aldosterone concentration to plasma renin activity. Clin. Chem. 51, 386–394 (2005)
W.F. Young, A.W. Stanson, G.B. Thompson, C.S. Grant, D.R. Farley, J.A. van Heerden, Role for adrenal venous sampling in primary aldosteronism. Surgery 136, 1227–1235 (2004)
F.E. Nwariaku, B.S. Miller, R. Auchus, S. Holt, L. Watumull, B. Dolmatch, S. Nesbitt, W. Vongpatanasin, R. Victor, F. Wians, E. Livingston, W.H. Snyder III, Primary hyperaldosteronism: effect of adrenal vein sampling on surgical outcome. Arch. Surg. 141, 497–503 (2006)
Acknowledgment
This work was supported by the 10th Five Years Programs for Science and Technology Development of China (2004BA720A29).
Conflict of interest
The authors have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yin, G., Zhang, S., Yan, L. et al. Effect of age on aldosterone/renin ratio (ARR) and comparison of screening accuracy of ARR plus elevated serum aldosterone concentration for primary aldosteronism screening in different age groups. Endocrine 42, 182–189 (2012). https://doi.org/10.1007/s12020-012-9609-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-012-9609-z