The Aldosterone Renin Ratio (ARR) APP as Tool to Enhance the Detection Rate of Primary Aldosteronism

  • Gian Paolo RossiEmail author
  • Valeria Bisogni
Short Communication


Primary aldosteronism is one of the most common forms of secondary hypertension, but it is often under diagnosed, which leads to the development of cardiovascular damage, and excess costs for long-term drug treatment and management of complications. The aldosterone to renin ratio (ARR) is a key step for early detection of primary aldosteronism, but unfortunately is not easily estimated. This is because plasma aldosterone and renin are measured with different assays, which provide results in different units of measure, with ensuing difficulty of obtaining the calculation of the ARR in the proper units and impossibility of interpreting results with reference to established cut off values. Therefore, doctors are often unable to draw unambiguous conclusions to be used for the clinical decision-making. To the aim of making the diagnostic work-up easier, we have developed an Application that provide a swift calculation of the ARR regardless of the units of measure used for plasma aldosterone and renin values. If the concomitant serum potassium level is available the App also provides the patient’s probability of having an aldosterone—producing adenoma based on a validated logistic discriminant analysis.


Arterial hypertension Primary aldosteronism Aldosterone Renin Ratio 



There are conflicts of interest to declare. We are grateful to Teresa Maria Seccia, MD, PhD, Giuseppe Maiolino, MD, PhD, and Giacomo Rossitto, MD, for helpful discussion.

Conflict of interest and sources of funding

All other authors declare that they have no conflict of interest. Grant support: FORICA (The FOundation for advanced Research In Hypertension and CArdiovascular diseases,, the Società Italiana dell’Ipertensione Arteriosa and the University of Padua to GPR. Research grant by the Young Research Program of the Italy’s Health Minister to L.L. Project GR-2009-1524351. No relationship with industry to be disclosed.

Disclosure summary

All authors have nothing to disclose

Supplementary material

Supplementary material 1 (MP4 6045 kb)


  1. 1.
    Rossi GP, Bernini G, Caliumi C, et al. PAPY Study Investigators. A prospective study of the prevalence of primary aldosteronism in 1125 hypertensive patients. J Am Coll Cardiol. 2006;48:2293–300.CrossRefPubMedGoogle Scholar
  2. 2.
    Rossi GP, Sechi LA, Giacchetti G, et al. Primary aldosteronism: cardiovascular, renal and metabolic implications. Trends Endocrinol Metab. 2008;19:88–90.CrossRefPubMedGoogle Scholar
  3. 3.
    Lubitz CC, Economopoulos KP, Sy S, et al. Cost-effectiveness of screening for primary aldosteronism and subtype diagnosis in the resistant hypertensive patients. Circ Cardiovasc Qual Outcomes. 2015;8:621–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Funder JW, Carey RM, Fardella C, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93:3266–81.CrossRefGoogle Scholar
  5. 5.
    Nishikawa T, Omura M, Satoh F, et al. Guidelines for the diagnosis and treatment of primary aldosteronism—the Japan Endocrine Society 2009. Endocr J. 2011;58:711–21.CrossRefPubMedGoogle Scholar
  6. 6.
    Rossi GP, Auchus RJ, Brown M, et al. An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension. 2014;63:151–60.CrossRefPubMedGoogle Scholar
  7. 7.
    Rossi GP. A comprehensive review of the clinical aspects of primary aldosteronism. Nat Rev Endocrinol. 2011;7:485–95.CrossRefPubMedGoogle Scholar
  8. 8.
    Mulatero P, Stowasser M, Loh KC, et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab. 2004;89:1045–50.CrossRefPubMedGoogle Scholar
  9. 9.
    Hiramatsu K, Yamada T, Yukimura Y, et al. A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Results in hypertensive patients. Arch Intern Med. 1981;141:1589–93.CrossRefPubMedGoogle Scholar
  10. 10.
    Rossi GP, Seccia TM, Palumbo G, et al. Primary Aldosteronism in the Prevalence in hYpertension (PAPY) Study Investigators. Within-patient reproducibility of the aldosterone: renin ratio in primary aldosteronism. Hypertension. 2010;55:83–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Rossi GP, Rossi E, Pavan E, et al. Screening for primary aldosteronism with a logistic multivariate discriminant analysis. Clin Endocrinol (Oxf). 1998;49:713–23.CrossRefPubMedGoogle Scholar
  12. 12.
    Rossi GP, Ceolotto G, Rossitto G, Seccia TM, Maiolino G, Berton C, Basso D, Plebani M. Prospective validation of an automated chemiluminescence-based assay of renin and aldosterone for the work-up of arterial hypertension. Clin Chem Lab Med. 2016. doi: 10.1515/cclm-2015-1094. PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Clinica dell’Ipertensione Arteriosa, Department of Medicine-DIMEDUniversity HospitalPadovaItaly

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