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Practical recommendations for antihypertensive therapy during the primary aldosteronism screening test

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Abstract

Background

The aldosterone-to-renin activity ratio (ARR) is recommended as a screening test for primary aldosteronism (PA). The use of antihypertensive medication is one of the most important factors to take into account when interpreting the ARR.

Objectives

The goal of this study was to compare the effect of various antihypertensive drug classes on biochemical testing and provide practical recommendations for antihypertensive medication regimens in patients suspected of having PA.

Methods

We retrospectively investigated 4218 hypertensive patients who underwent PA detection between January 2020 and February 2023. Finally, 25 patients with essential hypertension (EH) and 39 with PA were involved. The enrolled EH patients were selected from EH patients with at least two screening tests with interfering medication changes for at least 4 weeks.

Results

A total of 2/18 (11.1%) EH patients had opposite screening results after angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEIs), dihydropyridine-calcium channel blockers (DHP-CCBs) and diuretics were withdrawn. A total of 3/3 (100%) of the patients were initially screened as positive but had results that tested negative after β-blockers withdrawal. A total of 3/39 (7.7%) PA patients were misdiagnosed with EH with drug effects. Only plasma renin activity was markedly reduced after antihypertensive medication washout (P = 0.0173).

Conclusions

Not every patient receiving β-blockers, ACEIs, ARBs and DHP-CCBs with negative reports needed withdrawal or switching antihypertensive drugs. We recommend that patients be left on a regimen that includes β-blockers, ACEIs, ARBs, DHP-CCBs and spironolactone when determining the ARR during the initial test.

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Funding

The authors declare financial support was received for the research, authorship. Ningbo Key Clinical Specialty (Endocrinology) (Grant No. 2022-B07).

Author information

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo City, Zhejiang Province, China

    Jialin Li & Ling Li

  2. Zhejiang Lab, Hangzhou City, Zhejiang Province, China

    Hongzhou Yan

  3. Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co., Ltd., Hangzhou City, Zhejiang Province, China

    Xiuwen Lin, Zheng Zhao & Qi Zhang

  4. Department of Urology, The First Affiliated Hospital of Ningbo University, Ningbo city, Zhejiang province, China

    Cheng Zhou

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Contributions

All authors contributed to the study conception and design. Q.Z. provided the initial experimental design. Material preparation, data collection were performed by J.L., L.L. and C.Z. Analysis was performed by H.Y, X.L. and Z.Z. The first draft of the manuscript was written by J.L. and Q.Z. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Qi Zhang.

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Conflict of interest

The authors declare no competing interests.

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The authors affirm that human research participants provided informed consent for the publication of Table 1 and Figs.1–3.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the First Affiliated Hospital of Ningbo University (June 23, 2023/084RS).

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Informed consent was obtained from all individual participants included in the study.

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Li, J., Yan, H., Li, L. et al. Practical recommendations for antihypertensive therapy during the primary aldosteronism screening test. Endocrine 83, 188–195 (2024). https://doi.org/10.1007/s12020-023-03580-8

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