Functional tests for primary aldosteronism: value of captopril suppression

With the introduction of more simple screening tests such as the aldosterone/renin ratio, the detection rate of primary aldosteronism has increased considerably. Until now, no reference values have been available for reporting the aldosterone/renin ratio using plasma aldosterone values expressed in...

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Bibliographic Details
Published in:Current hypertension reports 2002-06, Vol.4 (3), p.245-249
Main Authors: Racine, Marie-Claude, Douville, Pierre, Lebel, Marcel
Format: Article
Language:English
Subjects:
Aldosterone - blood
Aldosterone - standards
Captopril
Humans
Hyperaldosteronism - blood
Hyperaldosteronism - diagnosis
Hypertension
Immunoradiometric Assay - standards
Ratios
Reference Values
Renin - blood
Renin - standards
Renin-Angiotensin System - drug effects
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Summary:With the introduction of more simple screening tests such as the aldosterone/renin ratio, the detection rate of primary aldosteronism has increased considerably. Until now, no reference values have been available for reporting the aldosterone/renin ratio using plasma aldosterone values expressed in SI units (pmol/L) and plasma active renin (ng/L) measured by immunoradiometric assay. We studied 153 subjects who had either normal blood pressure, essential hypertension, or primary aldosteronism. Essential hypertensive patients usually have aldosterone/renin (pmol/L/ng/L) ratios below 100, whereas ratios for patients with primary aldosteronism are above 140. Results that fall between 100 and 140 suggest a need for repeat testing. Patients with elevated aldosterone/renin ratios require confirmatory testing to demonstrate nonsuppressive autonomous aldosterone production. To this end, salt loading is widely used, but this approach may be contraindicated in patients with severe hypertension. The captopril suppression test appears as effective as salt loading in confirming a diagnosis of primary aldosteronism. In addition, the captopril test is safe, well tolerated, and cost-effective.
ISSN:1522-6417
1534-3111
DOI:10.1007/s11906-002-0014-5