scholarly journals Is the plasma aldosterone-to-renin ratio associated with blood pressure response to treatment in general practice?

2018 ◽  
Vol 36 (2) ◽  
pp. 154-161
Author(s):  
Sabine C Käyser ◽  
Bianca W M Schalk ◽  
Wim J C de Grauw ◽  
Tjard R Schermer ◽  
Reinier P Akkermans ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Antihypertensive Treatment ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Plasma Aldosterone ◽  
Target Blood Pressure ◽  
Response To Treatment ◽  
Newly Diagnosed ◽  
Aldosterone To Renin Ratio

Abstract Background Individualized antihypertensive treatment based on specific biomarkers such as renin may lead to more effective blood pressure control in patients with newly diagnosed essential hypertension. Recent studies suggested that the plasma aldosterone-to-renin ratio (ARR) may also be a candidate predictor for this purpose. Objective To assess whether the ARR is associated with the blood pressure response to antihypertensive treatment in patients with newly diagnosed hypertension. Methods In this prospective cohort study in primary care, we determined the ARR in patients with newly diagnosed hypertension prior to starting treatment. Treatment was categorized in five groups: no medication, use of angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker, use of calcium channel blocker, use of diuretic, or use of beta blocker. We examined the relation between the ARR and blood pressure response within 1 year of treatment, taking into account the type of antihypertensive treatment and adjusting for gender, age, baseline blood pressure, and comorbidity. Results Out of 304 patients, we used 947 measurements (727 no medication, 220 medication) for analysis. There was no association between the ARR and the response in blood pressure, and this applied to each treatment group. Target blood pressure, defined as systolic blood pressure <140 mmHg, was reached in 31% of patients. There was no association between the ARR and reaching target blood pressure (OR 1.002, 95% CI 0.983–1.022). Conclusion The ARR is not associated with the response in blood pressure within 1 year of antihypertensive treatment in primary care.

scholarly journals Prevalence of primary aldosteronism in primary care: a cross-sectional study

2018 ◽  
Vol 68 (667) ◽  
pp. e114-e122 ◽  
Author(s):  
Sabine C Käyser ◽  
Jaap Deinum ◽  
Wim JC de Grauw ◽  
Bianca WM Schalk ◽  
Hans JHJ Bor ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cross Sectional Study ◽  
Plasma Aldosterone ◽  
Infusion Test ◽  
Newly Diagnosed ◽  
Sectional Study ◽  
Cross Sectional ◽  
Plasma Aldosterone Concentration ◽  
Aldosterone To Renin Ratio

BackgroundPrimary aldosteronism (PA) is the most frequent cause of secondary hypertension. Reported prevalences of PA vary considerably because of a large heterogeneity in study methodology.AimTo examine the proportion of patients with PA among patients with newly diagnosed, never treated hypertension.Design and settingA cross-sectional study set in primary care.MethodGPs measured aldosterone and renin in adult patients with newly diagnosed, never treated hypertension. Patients with elevated aldosterone-to-renin ratio and increased plasma aldosterone concentration underwent a saline infusion test to confirm or exclude PA. The source population was meticulously assessed to detect possible selection bias.ResultsOf 3748 patients with newly diagnosed hypertension, 343 patients were screened for PA. In nine out of 74 patients with an elevated aldosterone-to-renin ratio and increased plasma aldosterone concentration the diagnosis of PA was confirmed by a saline infusion test, resulting in a prevalence of 2.6% (95% confidence interval = 1.4 to 4.9). All patients with PA were normokalaemic and 8 out of 9 patients had sustained blood pressure >150/100 mmHg. Screened patients were younger (P<0.001) or showed higher blood pressure (P<0.001) than non-screened patients.ConclusionIn this study a prevalence of PA of 2.6% in a primary care setting was established, which is lower than estimates reported from other primary care studies so far. This study supports the screening strategy as recommended by the Endocrine Society Clinical Practice Guideline. The low proportion of screened patients (9.2%), of the large cohort of eligible patients, reflects the difficulty of conducting prevalence studies in primary care clinical practice.

Age Dependency of Blood Pressure Response to Antihypertensive Treatment

1988 ◽  
Vol 12 ◽  
pp. S93-S97 ◽  
Author(s):  
Arie J. Man 't Veld ◽  
Anton H. van den Meiracker ◽  
Maarten A. Schalekamp
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Treatment ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Age Dependency

scholarly journals Blood pressure response to treatment of obese vs non‐obese adults with sleep apnea

2019 ◽  
Vol 21 (10) ◽  
pp. 1580-1590 ◽  
Author(s):  
Samuel T. Kuna ◽  
Raymond R. Townsend ◽  
Brendan T. Keenan ◽  
David Maislin ◽  
Thorarinn Gislason ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sleep Apnea ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Response To Treatment ◽  
Obese Adults

Study on clinical and endocrine characteristics of dexamethasone-suppressible hyperaldosteronism compared with those in primary aldosteronism owing to aldosterone-producing adenoma

1989 ◽  
Vol 121 (3) ◽  
pp. 334-344 ◽  
Author(s):  
Noriyoshi Yamakita ◽  
Keigo Yasuda ◽  
Nobuyasu Noritake ◽  
Leilani B. Mercado-Asis ◽  
Hiroshi Murase ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Aldosteronism ◽  
Blood Pressure Response ◽  
Laboratory Data ◽  
Japanese Patients ◽  
Pressure Response ◽  
Plasma Aldosterone ◽  
Vascular Damage ◽  
Aldosterone Producing Adenoma

Abstract. The clinical and endocrine characteristics of 12 Japanese patients with dexamethasone-suppressible hyperaldosteronism were compared with those in 49 Japanese patients with primary aldosteronism due to aldosteronoma. The results were as follows: 1. Most of the laboratory data in the two groups were almost the same. 2. The grade of vascular damage in both uncontrolled (3) and well-controlled (9) patients with dexamethasonesuppressible hyperaldosteronism did not correlate with blood pressure response. 3. The responsiveness of plasma aldosterone to exogenous ACTH in 6 patients with dexamethasone-suppressible hyperaldosteronism was not different from that in 9 patients with aldosteronoma. Even in 3 well-controlled patients in the former group, the plasma aldosterone response was as low as in all the 3 patients with small aldosteronomas. 4. In 4 patients with small aldosteronomas, plasma aldosterone was continuously suppressed with daily dexamethasone to the same degree as in dexamethasone-suppressible hyperaldosteronism. 5. The blood pressure, however, did not improve even in the patients with small aldosteronomas. The possible indistinguishable mechanism in dexamethasone-suppressible hyperaldosteronism and primary aldosteronism with small adenomas and the role of unknown hypertensinogenic steroid(s) other than aldosterone in inducing hypertension in dexamethasone-suppressible hyperaldosteronism are discussed.

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