Unadjusted Plasma Renin Activity as a "First-Look" Test to Decide Upon Further Investigations for Primary Aldosteronism

作者：Rye Peter; Chin Alex; Pasieka Janice; So Benny; Harvey Adrian; Kline Gregory^*

来源：Journal of Clinical Hypertension, 2015, 17(7): 541-546.

DOI：10.1111/jch.12523

The authors sought to define the 95th percentile of plasma renin activity (PRA) in a sample of patients with confirmed primary aldosteronism (PA) prior to adjustment of medications as a practical first-look test to identify those with very low ultimate likelihood of having PA. The aldosterone to renin ratio (ARR) was measured without adjustment of antihypertensive medications, with further workup as appropriate. Two groups were defined: patients with surgically confirmed PA (n=58) and patients with high-probability PA (n=59), defined as having any of the following: computed tomography-confirmed adrenal adenoma plus lateralizing adrenal vein sampling (AVS) without surgery, high ARR and hypokalemia but nonlateralizing AVS, or ARR more than four times the upper limit of normal. The PRA 95th percentile was 1.0ng/mL/h. All outliers had hypokalemia and two had adrenal adenomas. There was no difference between the confirmed and high probability groups. In the absence of highly suspicious clinical features, patients with unadjusted PRA >1.0ng/mL/h do not warrant further investigation for PA.

• 出版日期2015-7