The Aldosterone Renin Ratio (ARR) APP as Tool to Enhance the Detection Rate of Primary Aldosteronism
- PDF / 387,783 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 103 Downloads / 183 Views
SHORT COMMUNICATION
The Aldosterone Renin Ratio (ARR) APP as Tool to Enhance the Detection Rate of Primary Aldosteronism Gian Paolo Rossi1 • Valeria Bisogni1
Received: 7 January 2016 / Accepted: 9 February 2016 Ó Springer International Publishing Switzerland 2016
Abstract Primary aldosteronism is one of the most common forms of secondary hypertension, but it is often under diagnosed, which leads to the development of cardiovascular damage, and excess costs for long-term drug treatment and management of complications. The aldosterone to renin ratio (ARR) is a key step for early detection of primary aldosteronism, but unfortunately is not easily estimated. This is because plasma aldosterone and renin are measured with different assays, which provide results in different units of measure, with ensuing difficulty of obtaining the calculation of the ARR in the proper units and impossibility of interpreting results with reference to established cut off values. Therefore, doctors are often unable to draw unambiguous conclusions to be used for the clinical decision-making. To the aim of making the diagnostic work-up easier, we have developed an Application that provide a swift calculation of the ARR regardless of the units of measure used for plasma aldosterone and renin values. If the concomitant serum potassium level is available the App also provides the patient’s probability of having an aldosterone—producing adenoma based on a validated logistic discriminant analysis. Keywords Arterial hypertension Primary aldosteronism Aldosterone Renin Ratio
Electronic supplementary material The online version of this article (doi:10.1007/s40292-016-0132-9) contains supplementary material, which is available to authorized users. & Gian Paolo Rossi [email protected] 1
Clinica dell’Ipertensione Arteriosa, Department of Medicine-DIMED, University Hospital, Via Giustiniani, 2, 35126 Padova, Italy
1 Introduction In a recent multicentre randomized clinical trial comparing renal sympathetic denervation on top of optimized medical therapy with only optimized medical therapy, secondary hypertension forms were found in up 50 % of the patients with so called ‘‘resistant’’ or, better defined, ‘‘difficult to treat’’ arterial hypertension. Of the secondary forms of hypertension, primary aldosteronism (PA) is one of the most common [1]. Nonetheless, it is markedly under diagnosed. Multiple factors can account for its under detection, which translates into an excess cardiovascular damage [2], and thereby into an excess rate of cardiovascular and renal events, as well as into excess costs for longterm drug treatment and management of complications [3]. As all of these could be avoided with a timely diagnosis, efforts to improve and simplify the diagnostic approach to PA are fully justified and should be a major goal of research. Alongside the wrong perception among physicians that PA is quite rare, the complexity of the diagnostic work-up for PA is by no means one of the main factors, contributing to the under diagnosis of PA in
Data Loading...
