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Effect of Atenolol on Aldosterone/Renin Ratio Calculated by Both Plasma Renin Activity and Direct Renin Concentration in Healthy Male Volunteers

Background: The most popular screening test for primary aldosteronism (PAL) is the plasma aldosterone to renin ratio (ARR). Medications, dietary sodium, posture, and time of day all affect renin and aldosterone levels and can result in false-negative or -positive ARR if not controlled. Opinions are... Full description

Journal Title: The journal of clinical endocrinology and metabolism 2010, Vol.95 (7), p.3201-3206
Main Author: Ahmed, Ashraf H
Other Authors: Gordon, Richard D , Taylor, Paul , Ward, Gregory , Pimenta, Eduardo , Stowasser, Michael
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Bethesda, MD: Endocrine Society
ID: ISSN: 0021-972X
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title: Effect of Atenolol on Aldosterone/Renin Ratio Calculated by Both Plasma Renin Activity and Direct Renin Concentration in Healthy Male Volunteers
format: Article
creator:
  • Ahmed, Ashraf H
  • Gordon, Richard D
  • Taylor, Paul
  • Ward, Gregory
  • Pimenta, Eduardo
  • Stowasser, Michael
subjects:
  • Abridged Index Medicus
  • Adrenergic beta-Antagonists - pharmacology
  • Aldosterone - blood
  • Aldosterone - urine
  • Atenolol - pharmacology
  • Biological and medical sciences
  • Blood Pressure - drug effects
  • Chromatography, High Pressure Liquid
  • Creatinine - blood
  • Creatinine - urine
  • Endocrinopathies
  • Feeding. Feeding behavior
  • Fundamental and applied biological sciences. Psychology
  • Humans
  • Hydrocortisone - blood
  • Hydrocortisone - urine
  • Male
  • Medical sciences
  • Renin - blood
  • Renin - urine
  • Statistics, Nonparametric
  • Tandem Mass Spectrometry
  • Vertebrates: anatomy and physiology, studies on body, several organs or systems
  • Vertebrates: endocrinology
ispartof: The journal of clinical endocrinology and metabolism, 2010, Vol.95 (7), p.3201-3206
description: Background: The most popular screening test for primary aldosteronism (PAL) is the plasma aldosterone to renin ratio (ARR). Medications, dietary sodium, posture, and time of day all affect renin and aldosterone levels and can result in false-negative or -positive ARR if not controlled. Opinions are divided on whether β-adrenoreceptor blockers significantly affect the ARR. Methods: Normotensive, nonmedicated male volunteers (n = 21) underwent measurement (seated, midmorning) of plasma aldosterone (by HPLC-tandem mass spectrometry), direct renin concentration (DRC), renin activity (PRA), cortisol, electrolytes, and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline, and after 1 wk (25 mg daily) and 4 wk (50 mg daily for three additional weeks) of atenolol. Results: Compared with baseline, levels of aldosterone, DRC, and PRA were lower (P < 0.001) after both 1 and 4 wk [median (25–75th percentiles): baseline, 189 (138–357) pmol/liter, 40 (30–46) mU/liter, and 4.6 (2.7–5.8) ng/ml · h; 1 wk, 166 (112–310) pmol/liter, 34 (30–40) mU/liter, and 2.6 (2.0–3.1) ng/ml · h; 4 wk, 136 (97–269) pmol/liter, 16 (13–23) mU/liter, and 2.1(1.7–2.6) ng/ml · h, respectively]. ARR was significantly higher after 1 wk compared with baseline when calculated using PRA [61 (30–73) vs. 65 (44–130), P < 0.01] but not DRC [5 (4–7) vs. 5 (4–8)]. At 4 wk, ARR calculated by both PRA [78 (49–125)] and DRC [8 (6–14)] were significantly higher (P < 0.001) compared with baseline, and cortisol levels were significantly lower [92 (68–100) vs. 66 (48–91) ng/ml, P < 0.01]. There were no changes in plasma sodium, potassium, creatinine, or any urinary measurements. Conclusion: β-Blockers can significantly raise the ARR and thereby increase the risk of false positives during screening for PAL. Administration of atenolol is associated with a significant rise in the plasma aldosterone/renin ratio, suggesting that β-adrenoceptor agents increase the risk of false positive results when screening for primary aldosteronism.
language: eng
source:
identifier: ISSN: 0021-972X
fulltext: no_fulltext
issn:
  • 0021-972X
  • 1945-7197
url: Link


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titleEffect of Atenolol on Aldosterone/Renin Ratio Calculated by Both Plasma Renin Activity and Direct Renin Concentration in Healthy Male Volunteers
creatorAhmed, Ashraf H ; Gordon, Richard D ; Taylor, Paul ; Ward, Gregory ; Pimenta, Eduardo ; Stowasser, Michael
creatorcontribAhmed, Ashraf H ; Gordon, Richard D ; Taylor, Paul ; Ward, Gregory ; Pimenta, Eduardo ; Stowasser, Michael
descriptionBackground: The most popular screening test for primary aldosteronism (PAL) is the plasma aldosterone to renin ratio (ARR). Medications, dietary sodium, posture, and time of day all affect renin and aldosterone levels and can result in false-negative or -positive ARR if not controlled. Opinions are divided on whether β-adrenoreceptor blockers significantly affect the ARR. Methods: Normotensive, nonmedicated male volunteers (n = 21) underwent measurement (seated, midmorning) of plasma aldosterone (by HPLC-tandem mass spectrometry), direct renin concentration (DRC), renin activity (PRA), cortisol, electrolytes, and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline, and after 1 wk (25 mg daily) and 4 wk (50 mg daily for three additional weeks) of atenolol. Results: Compared with baseline, levels of aldosterone, DRC, and PRA were lower (P < 0.001) after both 1 and 4 wk [median (25–75th percentiles): baseline, 189 (138–357) pmol/liter, 40 (30–46) mU/liter, and 4.6 (2.7–5.8) ng/ml · h; 1 wk, 166 (112–310) pmol/liter, 34 (30–40) mU/liter, and 2.6 (2.0–3.1) ng/ml · h; 4 wk, 136 (97–269) pmol/liter, 16 (13–23) mU/liter, and 2.1(1.7–2.6) ng/ml · h, respectively]. ARR was significantly higher after 1 wk compared with baseline when calculated using PRA [61 (30–73) vs. 65 (44–130), P < 0.01] but not DRC [5 (4–7) vs. 5 (4–8)]. At 4 wk, ARR calculated by both PRA [78 (49–125)] and DRC [8 (6–14)] were significantly higher (P < 0.001) compared with baseline, and cortisol levels were significantly lower [92 (68–100) vs. 66 (48–91) ng/ml, P < 0.01]. There were no changes in plasma sodium, potassium, creatinine, or any urinary measurements. Conclusion: β-Blockers can significantly raise the ARR and thereby increase the risk of false positives during screening for PAL. Administration of atenolol is associated with a significant rise in the plasma aldosterone/renin ratio, suggesting that β-adrenoceptor agents increase the risk of false positive results when screening for primary aldosteronism.
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subjectAbridged Index Medicus ; Adrenergic beta-Antagonists - pharmacology ; Aldosterone - blood ; Aldosterone - urine ; Atenolol - pharmacology ; Biological and medical sciences ; Blood Pressure - drug effects ; Chromatography, High Pressure Liquid ; Creatinine - blood ; Creatinine - urine ; Endocrinopathies ; Feeding. Feeding behavior ; Fundamental and applied biological sciences. Psychology ; Humans ; Hydrocortisone - blood ; Hydrocortisone - urine ; Male ; Medical sciences ; Renin - blood ; Renin - urine ; Statistics, Nonparametric ; Tandem Mass Spectrometry ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Vertebrates: endocrinology
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0Effect of Atenolol on Aldosterone/Renin Ratio Calculated by Both Plasma Renin Activity and Direct Renin Concentration in Healthy Male Volunteers
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descriptionBackground: The most popular screening test for primary aldosteronism (PAL) is the plasma aldosterone to renin ratio (ARR). Medications, dietary sodium, posture, and time of day all affect renin and aldosterone levels and can result in false-negative or -positive ARR if not controlled. Opinions are divided on whether β-adrenoreceptor blockers significantly affect the ARR. Methods: Normotensive, nonmedicated male volunteers (n = 21) underwent measurement (seated, midmorning) of plasma aldosterone (by HPLC-tandem mass spectrometry), direct renin concentration (DRC), renin activity (PRA), cortisol, electrolytes, and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline, and after 1 wk (25 mg daily) and 4 wk (50 mg daily for three additional weeks) of atenolol. Results: Compared with baseline, levels of aldosterone, DRC, and PRA were lower (P < 0.001) after both 1 and 4 wk [median (25–75th percentiles): baseline, 189 (138–357) pmol/liter, 40 (30–46) mU/liter, and 4.6 (2.7–5.8) ng/ml · h; 1 wk, 166 (112–310) pmol/liter, 34 (30–40) mU/liter, and 2.6 (2.0–3.1) ng/ml · h; 4 wk, 136 (97–269) pmol/liter, 16 (13–23) mU/liter, and 2.1(1.7–2.6) ng/ml · h, respectively]. ARR was significantly higher after 1 wk compared with baseline when calculated using PRA [61 (30–73) vs. 65 (44–130), P < 0.01] but not DRC [5 (4–7) vs. 5 (4–8)]. At 4 wk, ARR calculated by both PRA [78 (49–125)] and DRC [8 (6–14)] were significantly higher (P < 0.001) compared with baseline, and cortisol levels were significantly lower [92 (68–100) vs. 66 (48–91) ng/ml, P < 0.01]. There were no changes in plasma sodium, potassium, creatinine, or any urinary measurements. Conclusion: β-Blockers can significantly raise the ARR and thereby increase the risk of false positives during screening for PAL. Administration of atenolol is associated with a significant rise in the plasma aldosterone/renin ratio, suggesting that β-adrenoceptor agents increase the risk of false positive results when screening for primary aldosteronism.
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0Abridged Index Medicus
1Adrenergic beta-Antagonists - pharmacology
2Aldosterone - blood
3Aldosterone - urine
4Atenolol - pharmacology
5Biological and medical sciences
6Blood Pressure - drug effects
7Chromatography, High Pressure Liquid
8Creatinine - blood
9Creatinine - urine
10Endocrinopathies
11Feeding. Feeding behavior
12Fundamental and applied biological sciences. Psychology
13Humans
14Hydrocortisone - blood
15Hydrocortisone - urine
16Male
17Medical sciences
18Renin - blood
19Renin - urine
20Statistics, Nonparametric
21Tandem Mass Spectrometry
22Vertebrates: anatomy and physiology, studies on body, several organs or systems
23Vertebrates: endocrinology
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titleEffect of Atenolol on Aldosterone/Renin Ratio Calculated by Both Plasma Renin Activity and Direct Renin Concentration in Healthy Male Volunteers
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2Aldosterone - blood
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6Blood Pressure - drug effects
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abstractBackground: The most popular screening test for primary aldosteronism (PAL) is the plasma aldosterone to renin ratio (ARR). Medications, dietary sodium, posture, and time of day all affect renin and aldosterone levels and can result in false-negative or -positive ARR if not controlled. Opinions are divided on whether β-adrenoreceptor blockers significantly affect the ARR. Methods: Normotensive, nonmedicated male volunteers (n = 21) underwent measurement (seated, midmorning) of plasma aldosterone (by HPLC-tandem mass spectrometry), direct renin concentration (DRC), renin activity (PRA), cortisol, electrolytes, and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline, and after 1 wk (25 mg daily) and 4 wk (50 mg daily for three additional weeks) of atenolol. Results: Compared with baseline, levels of aldosterone, DRC, and PRA were lower (P < 0.001) after both 1 and 4 wk [median (25–75th percentiles): baseline, 189 (138–357) pmol/liter, 40 (30–46) mU/liter, and 4.6 (2.7–5.8) ng/ml · h; 1 wk, 166 (112–310) pmol/liter, 34 (30–40) mU/liter, and 2.6 (2.0–3.1) ng/ml · h; 4 wk, 136 (97–269) pmol/liter, 16 (13–23) mU/liter, and 2.1(1.7–2.6) ng/ml · h, respectively]. ARR was significantly higher after 1 wk compared with baseline when calculated using PRA [61 (30–73) vs. 65 (44–130), P < 0.01] but not DRC [5 (4–7) vs. 5 (4–8)]. At 4 wk, ARR calculated by both PRA [78 (49–125)] and DRC [8 (6–14)] were significantly higher (P < 0.001) compared with baseline, and cortisol levels were significantly lower [92 (68–100) vs. 66 (48–91) ng/ml, P < 0.01]. There were no changes in plasma sodium, potassium, creatinine, or any urinary measurements. Conclusion: β-Blockers can significantly raise the ARR and thereby increase the risk of false positives during screening for PAL. Administration of atenolol is associated with a significant rise in the plasma aldosterone/renin ratio, suggesting that β-adrenoceptor agents increase the risk of false positive results when screening for primary aldosteronism.
copBethesda, MD
pubEndocrine Society
pmid20427490
doi10.1210/jc.2010-0225
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