Effect of postural changes on aldosterone to plasma renin ratio in patients with suspected secondary hypertension
| Autor: | Jacques Amar, E. Orloff, Béatrice Bouhanick, Bernard Chamontin, F. Ah-Kang, M. Barigou |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Supine position Posture Secondary hypertension Plasma renin activity chemistry.chemical_compound Primary aldosteronism Internal medicine Hyperaldosteronism Renin Renin–angiotensin system medicine Humans Prospective Studies Aldosterone Aldosterone-to-renin ratio business.industry Middle Aged medicine.disease Endocrinology chemistry Hypertension Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Annales de Cardiologie et d'Angéiologie. 64:169-174 |
| ISSN: | 0003-3928 |
| DOI: | 10.1016/j.ancard.2015.04.017 |
| Popis: | Aims To study the influence of postural changes on aldosterone to renin ratio (ARR) in patients with suspected secondary hypertension and to evaluate the sensitivity and specificity of the recommended seated ARR compared to supine and upright ARR for primary aldosteronism screening. Methods Fifty-three hypertensive patients were prospectively hospitalized for secondary hypertension exploration (age: 51 ± 12, 66% males). After withdrawal of drugs interfering with renin angiotensin system, plasma aldosterone and direct renin concentration were measured in the morning, at bed after an overnight supine position, then out of bed after 1 hour of upright position and finally 2 hours later after 15 minutes of seating. Minimal renin value was set at 5 μUI/mL. Results Referring to ARR cut-off of 23 pg/μUI, the sensitivity of seated ARR was 57.1% and specificity was 92.3%. The negative and positive predictive values were 95.1% and 45.2% respectively. Compared to these results, a cut-off of 19 improved sensitivity to 85.7% with a specificity of 89.7%. Negative and positive predictive values were 98.3% and 41.1% respectively. Seated ARR mean value was lower than supine and upright ARR mean values, due to an overall increase in renin at seating compared to the supine position by factor 1.9 while aldosterone just slightly increased by factor 1.2. Seated ARR correlated to supine and upright ARR: correlation coefficients ( r ) 0.90 and 0.93 respectively ( P Conclusions Current recommended measurement of ARR in the seating position is fairly correlated to supine and upright ARR. A suggested cut-off value of 19 instead of 23 pg/μUI increased the discriminating power of this test. |
| Databáze: | OpenAIRE |
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