Aldosterone and Renin Measurements in the Management of Patients with Hypertension

Primary Aldosteronism (PA) is a specifically treatable and potentially curable form of secondary hypertension. However, despite the recommendations of the Endocrine Society Guidelines and the European Society of Hypertension, Primary Aldosteronism is still largely underdiagnosed and undertreated. The Prevalence of PA among the general and resistant hypertensive population ranges from 5-20%.The Aldosterone to Renin Ratio (ARR) is routinely used as a screening test to diagnose Primary Aldosteronism in hypertensive individuals. The diagnostic algorithm also involves confirmation tests followed by lateralization studies to distinguish between unilateral and bilateral disease. PA requires a specific pharmacological treatment with mineralcorticoid receptors antagonist or with unilateral adrenalectomy. These treatments have shown to reduce the excess of cardiovascular risk characteristically associated with the disease. Reduced or absent compliance to anti-hypertensive treatments is a major obstacle to the achievement of blood pressure in patients with arterial hypertension. Current methods for therapeutic adherence assessment display low accuracy, limited applicability in clinical practice and/or high costs. Serial measurements of Aldosterone to Renin Ratio (ARR) were evaluated to assess the therapeutic compliance to RAAS inhibitors. A significant increase of renin levels and reduction of aldosterone levels after RAAS inhibitors initiation was observed with subsequent reduction of ARR. Delta ARR, defined as relative change before and after treatment initiation, provided high accuracy for determination of therapeutic compliance.

 

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