Mineralocorticoid Receptor Blockers and Aldosterone to Renin Ratio: A Randomized Controlled Trial and Observational Data.

Abstract

Current guidelines recommend to withdraw mineralocorticoid receptor (MR) blocker treatment for at least 4 weeks when measuring the aldosterone to renin ratio (ARR) as a screening test for primary aldosteronism (PA). We aimed to evaluate the effect of MR blocker treatment on ARR and its components, plasma aldosterone concentration (PAC), and direct renin concentration (DRC). First, we performed a post-hoc analysis of the effect of eplerenone on parathyroid hormone levels in primary hyperparathyroidism (EPATH) study, a randomized controlled trial (RCT) in 110 patients with primary hyperparathyroidism (pHPT). Patients were 1:1 randomly assigned to receive either 25 mg eplerenone once daily (up-titration after 4 weeks to 50 mg/day) or placebo for 8 weeks. Second, we measured the ARR in 4 PA patients from the Graz Endocrine Causes of Hypertension Study (GECOH) before and after MR blocker treatment. Ninety-seven participants completed the EPATH trial, and the mean treatment effect (95% confidence interval) for log(e)ARR was 0.08 (-0.32 to 0.48) ng/dl/μU/ml (p=0.694). The treatment effect was 0.71 (0.47 to 0.96; p<0.001) ng/dl for log(e)PAC and 0.64 (0.19 to 1.10; p=0.006) μU/ml for log(e)DRC, respectively. In the 4 PA patients, the ARR decreased from 11.24±3.58 at baseline to 2.70±1.03 (p=0.013) ng/dl/μU/ml after MR blocker treatment. In this study with limited sample size, MR blocker treatment did not significantly alter the ARR in pHPT patients but significantly reduced the ARR in PA patients. Diagnostic utility of ARR and its components for PA diagnostics under MR blocker treatment warrants further study.

• Authors: Stefan Pilz, Christian Trummer, Nicolas Verheyen, Verena Schwetz, Marlene Pandis, Felix Aberer, Martin R Grübler, Andreas Meinitzer, Antonia Bachmann, Jakob Voelkl, Ioana Alesutan, Cristiana Catena, Leonardo A Sechi, Winfried März, Barbara Obermayer-Pietsch, Andreas Tomaschitz
• Journal: Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme (Horm Metab Res) Vol. 50 Issue 5 Pg. 375-382 (May 2018) ISSN: 1439-4286 [Electronic] Germany
• PMID: 29723896 (Publication Type: Journal Article, Observational Study, Randomized Controlled Trial)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Mineralocorticoid Receptor Antagonists
• Spironolactone
• Aldosterone
• Eplerenone
• Renin

Topics

• Aged
• Aldosterone (blood)
• Double-Blind Method
• Eplerenone
• Female
• Humans
• Hyperaldosteronism (blood, drug therapy)
• Hyperparathyroidism (blood, drug therapy)
• Male
• Middle Aged
• Mineralocorticoid Receptor Antagonists (administration & dosage, adverse effects)
• Renin (blood)
• Spironolactone (administration & dosage, adverse effects, analogs & derivatives)
• Time Factors