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Horm Metab Res 2018; 50(05): 375-382
DOI: 10.1055/a-0604-3249
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

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

Stefan Pilz   *
1   Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
,
Christian Trummer   *
1   Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
,
Nicolas Verheyen
2   Department of Cardiology, Medical University of Graz, Graz, Austria
,
Verena Schwetz
1   Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
,
Marlene Pandis
1   Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
,
Felix Aberer
1   Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
,
Martin R. Grübler
3   Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
,
Andreas Meinitzer
4   Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
,
Antonia Bachmann
1   Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
,
Jakob Voelkl
5   Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Berlin, Germany
,
Ioana Alesutan
5   Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Berlin, Germany
,
Cristiana Catena
6   Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
,
Leonardo A. Sechi
6   Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
,
Winfried März
4   Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
7   Synlab Academy, Synlab Services GmbH, Mannheim, Germany
,
Barbara Obermayer-Pietsch
1   Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
,
Andreas Tomaschitz
8   Bad Gleichenberg Clinic, Bad Gleichenberg, Austria
› Author Affiliations
Further Information

Publication History

received 12 January 2018

accepted 08 March 2018

Publication Date:
03 May 2018 (online)

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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.

Key words

eplerenone - spironolactone - ARR - RCT - placebo

* These authors contributed equally as first authors to this manuscript


 

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