RAS-challenge as a first-look test for detection of primary aldosteronism in patients with treatment-resistant hypertension
Purpose Primary aldosteronism (PA), characterised by low-renin hypertension, confers a high cardiovascular risk and is the most common cause of secondary hypertension, with an increased prevalence in patients with treatment-resistant hypertension. However, it is estimated that only a small percentag...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Blood Pressure |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/08037051.2023.2179340 |
| _version_ | 1827809017937788928 |
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| author | Christian Beger Theresa Karg Jan B. Hinrichs Bastian Ringe Hermann Haller Bernhard C. Meyer Florian P. Limbourg |
| author_facet | Christian Beger Theresa Karg Jan B. Hinrichs Bastian Ringe Hermann Haller Bernhard C. Meyer Florian P. Limbourg |
| author_sort | Christian Beger |
| collection | DOAJ |
| description | Purpose Primary aldosteronism (PA), characterised by low-renin hypertension, confers a high cardiovascular risk and is the most common cause of secondary hypertension, with an increased prevalence in patients with treatment-resistant hypertension. However, it is estimated that only a small percentage of affected patients are identified in routine clinical practice. Inhibitors of the renin-angiotensin system cause an increase in renin levels in patients with intact aldosterone regulation, and inadequate low renin with concurrent RAS inhibition (RASi) may therefore indicate PA, which could serve as a first look screening test for selection for formal work-up. Methods We analysed patients between 2016–2018 with treatment-resistant hypertension who had inadequate low renin in the presence of RASi (i. e. at risk for PA) and who were offered systematic work-up with adrenal vein sampling (AVS). Results A total of 26 pts were included in the study (age 54.8 ± 11, male 65%). Mean office blood pressure (BP) was 154/95 mmHg on 4.5 antihypertensive drug classes. AVS had a high technical success rate (96%) and demonstrated unilateral disease in the majority of patients (57%), most of which (77%) were undetected by cross-sectional imaging. Conclusion In patients with resistant hypertension, low renin in the presence of RASi is a strong indicator for autonomous aldosterone secretion. It may serve as an on-medication screening test for PA to select for formal PA work up. |
| first_indexed | 2024-03-11T22:36:29Z |
| format | Article |
| id | doaj.art-f96710de0f3c460a9e34471a76b3bfd2 |
| institution | Directory Open Access Journal |
| issn | 0803-7051 1651-1999 |
| language | English |
| last_indexed | 2024-03-11T22:36:29Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Blood Pressure |
| spelling | doaj.art-f96710de0f3c460a9e34471a76b3bfd22023-09-22T13:57:06ZengTaylor & Francis GroupBlood Pressure0803-70511651-19992023-12-0132110.1080/08037051.2023.21793402179340RAS-challenge as a first-look test for detection of primary aldosteronism in patients with treatment-resistant hypertensionChristian Beger0Theresa Karg1Jan B. Hinrichs2Bastian Ringe3Hermann Haller4Bernhard C. Meyer5Florian P. Limbourg6Department of Nephrology and Hypertension, Hannover Medical SchoolDepartment of Nephrology and Hypertension, Hannover Medical SchoolDepartment of Diagnostic and Interventional Radiology, Hannover Medical SchoolDepartment of General, Visceral and Transplantation Surgery, Hannover Medical SchoolDepartment of Nephrology and Hypertension, Hannover Medical SchoolDepartment of Diagnostic and Interventional Radiology, Hannover Medical SchoolDepartment of Nephrology and Hypertension, Hannover Medical SchoolPurpose Primary aldosteronism (PA), characterised by low-renin hypertension, confers a high cardiovascular risk and is the most common cause of secondary hypertension, with an increased prevalence in patients with treatment-resistant hypertension. However, it is estimated that only a small percentage of affected patients are identified in routine clinical practice. Inhibitors of the renin-angiotensin system cause an increase in renin levels in patients with intact aldosterone regulation, and inadequate low renin with concurrent RAS inhibition (RASi) may therefore indicate PA, which could serve as a first look screening test for selection for formal work-up. Methods We analysed patients between 2016–2018 with treatment-resistant hypertension who had inadequate low renin in the presence of RASi (i. e. at risk for PA) and who were offered systematic work-up with adrenal vein sampling (AVS). Results A total of 26 pts were included in the study (age 54.8 ± 11, male 65%). Mean office blood pressure (BP) was 154/95 mmHg on 4.5 antihypertensive drug classes. AVS had a high technical success rate (96%) and demonstrated unilateral disease in the majority of patients (57%), most of which (77%) were undetected by cross-sectional imaging. Conclusion In patients with resistant hypertension, low renin in the presence of RASi is a strong indicator for autonomous aldosterone secretion. It may serve as an on-medication screening test for PA to select for formal PA work up.http://dx.doi.org/10.1080/08037051.2023.2179340hypertensionblood pressureprimary aldosteronismrenin |
| spellingShingle | Christian Beger Theresa Karg Jan B. Hinrichs Bastian Ringe Hermann Haller Bernhard C. Meyer Florian P. Limbourg RAS-challenge as a first-look test for detection of primary aldosteronism in patients with treatment-resistant hypertension Blood Pressure hypertension blood pressure primary aldosteronism renin |
| title | RAS-challenge as a first-look test for detection of primary aldosteronism in patients with treatment-resistant hypertension |
| title_full | RAS-challenge as a first-look test for detection of primary aldosteronism in patients with treatment-resistant hypertension |
| title_fullStr | RAS-challenge as a first-look test for detection of primary aldosteronism in patients with treatment-resistant hypertension |
| title_full_unstemmed | RAS-challenge as a first-look test for detection of primary aldosteronism in patients with treatment-resistant hypertension |
| title_short | RAS-challenge as a first-look test for detection of primary aldosteronism in patients with treatment-resistant hypertension |
| title_sort | ras challenge as a first look test for detection of primary aldosteronism in patients with treatment resistant hypertension |
| topic | hypertension blood pressure primary aldosteronism renin |
| url | http://dx.doi.org/10.1080/08037051.2023.2179340 |
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