Download Guidelines for the diagnosis of primary aldosteronism

Supplementary material:
Guide to management of hypertension 2008
Guidelines for the diagnosis
of primary aldosteronism
Primary aldosteronism occurs in 5–10% of patients with hypertension and is not
excluded by normal serum potassium.1 It should be considered in all patients with
hypertension, especially patients with moderate to severe, or treatment-resistant,
hypertension, and in patients with hypokalemia.
Testing for primary aldosteronism is performed by
measurement of plasma aldosterone:renin ratio in a
morning blood sample (after the patient has been upright
for at least two hours) taken while the patient is seated.2
Medications can confound interpretation of this ratio.2,3
• False positive results may be obtained in patients
who are taking beta-blockers or non-steroidal
anti-inflammatory drugs.
• False negative results may be obtained in patients
who are taking diuretics (including spironolactone),
angiotensin-converting enzyme inhibitors,
angiotensin II receptor antagonists or some calcium
channel blockers (including nifedipine, felodipine
and amlodipine).
Ideally, testing should be performed at least four to six
weeks after ceasing diuretics and at least two to four
weeks after ceasing the other agents listed above. During
this time, control of hypertension should be maintained
by using other medications that have lesser effects on
the ratio, including verapamil slow-release, with the
addition of hydralazine, prazosin, or both, if needed.
We recommend that health professionals refer patients
to a specialist for further investigation if primary
aldosteronism is suspected.
References
1.Mulatero, P, Stowasser M, Loh, K-C et al. Increased diagnosis of primary
aldosteronism, including surgically correctable forms, in centers from
five continents. J Clin Endocrinol Metab 2004; 89: 1045–50.
2. Stowasser, M, Gordon, RD. The aldosterone-renin ratio for screening for
primary aldosteronism. Endocrinologist 2004; 14: 267–76.
3. Mulatero, P, Rabbia, F, Milan, A, et al: Drug effects on aldosterone/
plasma renin activity ratio in primary aldosteronism. Hypertension
2002; 40: 897–902.
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© 2008 National Heart Foundation of Australia ABN 98 008 419 761
PRO-065 (supplementary material for PRO-052 and PRO-063)
Disclaimer: This document has been produced by the National Heart Foundation of Australia for the information of health professionals. The statements
and recommendations it contains are, unless labelled as ‘expert opinion’, based on independent review of the available evidence. Interpretation of this
document by those without appropriate medical and/or clinical training is not recommended, other than at the request of, or in consultation with, a
relevant health professional.
Heart Foundation Guide to hypertension: Guidelines for the diagnosis of primary aldosteronism
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