Re: Aldosterone to Renin Ratio (What does it mean?)

[Guest guest]

What is the difference between low renin hypertension and PA?

Val

[Guest guest]

In a message dated 12/31/07 9:37:46 PM, val@... writes:

>

> What is the difference between low renin hypertension and PA?

>

> Val

>

>

>

If you read my article you will note that LR HT is a early stage of PA.

May your pressure be low!

Clarence E. Grim, BS, MS, MD

Senior Consultant to Shared Care Research and Consulting, Inc.

(sharedcareinc.com)

Clinical Professor of Internal Medicine and Epidemiology Med. Col. WI

Clinical Professor of Nursing, Univ. of WI, Milwaukee

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

**************************************

See AOL's top rated recipes

(http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004)

[Guest guest]

Every lab has diffenent normal values and they cannot be interchanged.

Trust all tests were done in the same lab.

As you can see the major reason for the variation in the ration is the aldo.

Aldo varies by time of day and how long you have been up. Try to identify

the times the test was done and how long you had been out of bed to see if the

Am values are higher than the PM.

In a message dated 12/31/07 8:38:01 PM, airlinerg@... writes:

>

> Airlinerg's Aldosterone / Renin test results:

>

> On 10/29/07 my Aldosterone was 31 and my Renin was 0.2 so the ratio

> was 155.

>

> On 7/30/07 my Aldosterone was 20 and my Renin was 0.2 so the ratio was

> 100.

>

> On 4/30/07 my Aldosterone was 24 and my Renin was 0.2 so the ratio was

> 120.

>

> On 2/9/07 my Aldosterone was 42 and my Renin was 0.3 so the ratio was

> 140.

>

> What does this mean?

>

> 1st study below says:

>

> In the absence of hypokalaemia, a low plasma renin is a sufficient

> and simple way of detecting spironolactone responders among patients

> with resistant hypertension.

>

> 2nd study below says:

>

> In this study, an ARR >66.9 after 30 minutes seated confirmed primary

> hyperaldosteronism, whereas an ARR <23.6 excluded it with near

> certainty.

>

> ____________ ________ ________ ________ ________ ________

>

> In an article at:

>

> http://www-

> clinpharm.medschl. clinpharm clinpharm.medsc clinpharm.me clinphar clin

> 5_55.pdf

>

> Prevalence of primary hyperaldosteronism assessed

> by aldosterone/ by aldosterone/<wbr>renin ratio and s

>

> by Sue Hood, Cannon, Foo and Brown

>

> ABSTRACT - Recent studies have suggested that

> primary hyperaldosteronism may be present in

> more than 10% of patients with hypertension.

>

Dr. Grim: as noted in recent post we reported this nearly 30 years ago.

> We

> aimed to estimate the prevalence in unselected

> patients in primary care, and investigate the

> influence of current drug treatment upon the

> aldosterone/ aldosterone/<wbr>renin ratio (ARR)

> of blood pressure response to spironolactone. We

> measured blood pressure, plasma electrolytes,

> renin activity and aldosterone in 846 patients

> with hypertension. Spironolactone 50 mg was

> prescribed for one month to patients with blood

> pressure >130/85 mmHg and ARR >400. The

> primary outcome measure was to discover the

> proportion of patients with plasma aldosterone

> >400 pmol/l and ARR >800 and either an adrenal

> adenoma on computed tomography scan or a

> systolic blood pressure response to spironolactone

> >20 mmHg. Only one patient had an adenoma,

> and only 16 (1.8%) had both a plasma

> aldosterone >400 pmol/l and ARR >800. By contrast,

> 119 patients (14.1%) had an elevated ARR

> but normal plasma aldosterone. In 69 patients

> out of the 119 who received spironolactone,

> blood pressure fell by 26/11 mmHg. These

> patients were normokalaemic but had uncontrolled

> hypertension despite multiple drugs. The

> response to spironolactone was best predicted by

> a low plasma renin, <0.5 pmol/ml/h (<10 mU/l),

> despite treatment with an ACE inhibitor. We concluded

> that adrenal adenomas are an uncommon

> cause of hypertension. In the absence of

> hypokalaemia, a low plasma renin is a sufficient

> and simple way of detecting spironolactone responders

> among patients with resistant hypertension.

> Only patients with both hypokalaemia

> and low plasma renin, measured while the patient

> is off | " ) blockade, require measurement of aldosterone.

> A plasma aldosterone >400 pmol/l

> together with renin activity <;0.5 pmol/ml/h

> should trigger further investigations for an

> adrenal adenoma.

>

> ____________ ________ ________ ________ ________ ________

>

> Another article at:

>

> http://general-http://gehttp://genehttp://generhttp://genhttp:

>

> Aldosterone- Aldosterone-<wbr>Renin Ratio in Primary

>

> by Allan S. Brett, MD

>

> Determining the ARR was enough to confirm or exclude diagnoses of

> primary aldosteronism in some, but not all, cases; it's probably best

> to make sure that patients are evaluated by experienced physicians.

>

> The aldosterone- The aldosterone-<wbr>renin ratio (ARR) has gained popu

> test for primary hyperaldosteronism, a probably underdiagnosed cause

> of hypertension. However, studies have yielded varying definitions of

> a positive test.

>

> In this retrospective study from Hong Kong, researchers analyzed

> results from 62 patients referred to a hospital's endocrine unit with

> suspected primary hyperaldosteronism (usually because of hypertension

> plus hypokalemia) plus hypokalemia)<wbr>. Final diagnoses were based

> saline suppression tests, computed tomography findings, and adrenal

> venous sampling (not all patients underwent all tests). ARRs were

> determined in each patient after overnight recumbency, after sitting

> for 30 minutes, and after 4 hours of ambulation.

>

> Primary hyperaldosteronism ultimately was diagnosed in 45 patients;

> the other 17 were presumed to have essential hypertension. After

> reviewing all ARR results, the authors conclude that testing patients

> after 30 minutes seated is acceptable for screening. An ARR cutoff of

> 23.6 ng/dL per ng/mL · hour had a sensitivity of 97% and specificity

> of 94%. A cutoff of 66.9 yielded 100% specificity: All patients with

> levels above this cutoff had primary hyperaldosteronism. The median

> ARR was 136.4 among patients with hyperaldosteronism and 5.6 among

> controls.

>

> Comment: In this study, an ARR >66.9 after 30 minutes seated confirmed

> primary hyperaldosteronism, whereas an ARR <23.6 excluded it with near

> certainty. Between these two cutoffs, additional tests were needed to

> confirm or exclude the diagnosis. Because of other important variables

> (e.g., performance of specific test kits, differing patient

> populations across studies), it's probably best to have patients

> evaluated by physicians with experience in diagnosing primary

> hyperaldosteronism.

>

> — Allan S. Brett, MD

>

>

May your pressure be low!

Clarence E. Grim, BS, MS, MD

Senior Consultant to Shared Care Research and Consulting, Inc.

(sharedcareinc.com)

Clinical Professor of Internal Medicine and Epidemiology Med. Col. WI

Clinical Professor of Nursing, Univ. of WI, Milwaukee

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

**************************************

See AOL's top rated recipes

(http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004)