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The Aldosterone–Renin Ratio: Role and Problems

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Abstract

The major role of the aldosterone/renin ratio (ARR) test is in screening hypertensive patients for primary aldosteronism (PA). Although currently the most reliable and popular approach, the value of this screening test depends on an appreciation of factors (such as antihypertensive and other medications, posture, time of day, age, gender, phase of menstrual cycle, diet, presence of hypokalemia, medications, and renal function) which can affect the results, on the care with which either these factors are controlled or their effects taken into account, and on access to reliable and reproducible assays for renin and aldosterone. Even then, physiological day-to-day variability reduces the value of a single estimation, and repeated testing is advisable before deciding whether or not to proceed to further diagnostic work-up. Provided that testing of aldosterone suppressibility is always carried out in order to confirm or exclude the diagnosis, and adrenal venous sampling is employed to differentiate unilateral from bilateral forms, wide application of the ARR can have a major beneficial clinical impact, with improved therapeutic outcomes, including possible cure in those with unilateral disease and improved quality of life.

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Authors and Affiliations

  1. Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, QLD, 4102, Australia

    Michael Stowasser M.B.B.S., F.R.A.C.P., Ph.D.

  2. Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes Hospital, Brisbane, QLD, 4120, Australia

    Richard Douglas Gordon M.B.B.S., M.D., Ph.D., F.R.A.C.P., F.R.C.P.

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  1. Michael Stowasser M.B.B.S., F.R.A.C.P., Ph.D.
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Correspondence to Michael Stowasser M.B.B.S., F.R.A.C.P., Ph.D. .

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  1. Department of Surgery, University Hospital, Uppsala, Sweden

    Per Hellman

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Stowasser, M., Gordon, R.D. (2014). The Aldosterone–Renin Ratio: Role and Problems. In: Hellman, P. (eds) Primary Aldosteronism. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0509-6_9

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