Practical recommendations for antihypertensive therapy during the primary aldosteronism screening test

Area of Science:

• Endocrinology
• Hypertension Management
• Clinical Biochemistry

Background:

• The aldosterone-to-renin activity ratio (ARR) is a key screening tool for primary aldosteronism (PA).
• Interpreting ARR results is significantly influenced by concurrent antihypertensive medication use.

Purpose of the Study:

• To evaluate the impact of various antihypertensive drug classes on biochemical markers used in PA screening.
• To provide evidence-based recommendations for antihypertensive medication regimens in patients undergoing PA evaluation.

Main Methods:

• Retrospective analysis of 4218 hypertensive patients screened for PA between January 2020 and February 2023.
• Inclusion of 25 essential hypertension (EH) and 39 PA patients, with EH patients having medication changes for at least 4 weeks prior to repeat testing.

Main Results:

• 11.1% of EH patients showed altered screening results after withdrawal of ARBs, ACEIs, DHP-CCBs, or diuretics.
• 100% of patients on beta-blockers initially screened positive but became negative after withdrawal.
• Drug effects led to misdiagnosis in 7.7% of PA patients.
• Plasma renin activity significantly decreased post-medication washout (P=0.0173).

Conclusions:

• Withdrawal or switching of beta-blockers, ACEIs, ARBs, and DHP-CCBs is not always necessary for patients with negative screening results.
• It is recommended to maintain regimens including beta-blockers, ACEIs, ARBs, DHP-CCBs, and spironolactone during initial ARR testing for PA.