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Title: | Age- and sex-specific reference ranges are needed for the aldosterone/renin ratio. | Authors: | Fuller P.J.;Yang J. ;Solanki P.;Gwini S.M.;Doery J.C.G. ;Choy K.W.;Shen J.;Young M.J. | Monash Health Department(s): | Endocrinology | Institution: | (Solanki, Choy, Shen, Fuller, Yang) Department of Endocrinology, Monash Health, Clayton, Vic., Australia (Solanki, Doery, Yang) Department of Medicine, Monash University, Clayton, Vic., Australia (Gwini) Barwon Health, University Hospital Geelong, Geelong, Vic., Australia (Gwini) School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia (Shen, Young, Fuller, Yang) Hudson Institute of Medical Research, Clayton, Vic., Australia | Issue Date: | 27-Aug-2020 | Copyright year: | 2020 | Publisher: | Blackwell Publishing Ltd | Place of publication: | United Kingdom | Publication information: | Clinical Endocrinology. 93 (3) (pp 221-228), 2020. Date of Publication: 01 Sep 2020. | Journal: | Clinical Endocrinology | Abstract: | Objective: Current Endocrine Society Clinical Practice Guidelines use a specific aldosterone/renin ratio (ARR) threshold to screen for primary aldosteronism (a treatable disease causing up to 15% of hypertension in primary care) in all patients. We sought to characterize demographic variations in the ARR, hypothesizing a need for age- and sex-specific reference ranges to improve the accuracy of the test. Design(s): Retrospective cross-sectional analysis of ARR measurements at a single tertiary hospital from December 2016 to June 2018. Patient(s): A total of 442 patients with clinically indicated ARR were included, after excluding those who were on spironolactone or the oral contraceptive pill, were pregnant or had an existing adrenal condition. Measurements: Aldosterone, renin and the ARR. Result(s): Among those aged 20-39 years (n = 74), females had significantly higher median aldosterone (369 vs 244 pmol/L, P =.028), lower median renin (17.0 vs 27.6 mIU/L, P =.034) and higher median ARR (20.7 vs 10.3 (pmol/L)/(mIU/L), P =.001) than males, despite having lower systolic (135 vs 145 mmHg, P =.021) and diastolic (89 vs 96.5 mmHg, P =.007) blood pressure. The >= 60-year age group (n = 157) also had significant sex differences in the ARR. With increasing age (20-39 vs >= 60 years), there was a significant fall in plasma aldosterone in females (369 pmol/L vs 264 pmol/L, P =.005), with no change observed in males. Conclusion(s): For those 20-39 years old, aldosterone and the ARR are significantly higher in females despite a lower systolic and diastolic BP, highlighting the potential for false-positive results. Our findings indicate the need for prospective studies with a control population to define age- and sex-specific ARR reference ranges.Copyright © 2020 John Wiley & Sons Ltd | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1111/cen.14199 | PubMed URL: | 32306417 [http://www.ncbi.nlm.nih.gov/pubmed/?term=32306417] | ISSN: | 0300-0664 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/29203 | Type: | Article | Subjects: | alpha 1 adrenergic receptor blocking agent/dt [Drug Therapy] angiotensin receptor antagonist/dt [Drug Therapy] antihypertensive agent/dt [Drug Therapy] beta adrenergic receptor blocking agent/dt [Drug Therapy] calcium channel blocking agent/dt [Drug Therapy] dihydropyridine/dt [Drug Therapy] dipeptidyl carboxypeptidase inhibitor/dt [Drug Therapy] diuretic agent/dt [Drug Therapy] nitrate/dt [Drug Therapy] *renin/ec [Endogenous Compound] *aldosterone renin ratio male adult aldosterone blood level article *concentration ratio cross-sectional study diastolic blood pressure false positive result female *groups by age human hypertension/dt [Drug Therapy] major clinical study priority journal *reference value retrospective study *sex difference sex ratio systolic blood pressure tertiary care center *aldosterone/ec [Endogenous Compound] alpha 1 adrenergic receptor blocking agent angiotensin receptor antagonist antihypertensive agent beta adrenergic receptor blocking agent calcium channel blocking agent dihydropyridine dipeptidyl carboxypeptidase inhibitor diuretic agent nitrate renin aldosterone renin ratio aldosterone blood level concentration ratio diastolic blood pressure false positive result hypertension reference value sex difference sex ratio systolic blood pressure tertiary care center aldosterone hypertension / drug therapy major clinical study male priority journal *reference value retrospective study *sex difference sex ratio adult tertiary care center systolic blood pressure aldosterone blood level Article *concentration ratio cross-sectional study diastolic blood pressure false positive result female *groups by age human |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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