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Review Article

Is aldosterone the missing link in refractory hypertension?: aldosterone-to-renin ratio as a marker of inappropriate aldosterone activity

Journal of Human Hypertension volume 16, pages 153–158 (2002)Cite this article

Abstract

Use of the random aldosterone-to-renin ratio (ARR) as a reliable marker of inappropriate aldosterone activity has led to primary aldosteronism (PA) being increasingly diagnosed in hypertensive patients. At least 10% of hypertensives have been found to have PA, the majority of whom presumably have bilateral adrenal hyperplasia or idiopathic hyperaldosteronism as an aetiology for PA. Whilst these patients clearly have excess aldosterone activity, they have in common many features that are found in hypertensive patients in general, amongst which include heightened angiotensin II adrenal sensitivity. Whether these individuals belong within the spectrum of ‘essential hypertension’ is being debated, but is probably irrelevant clinically since they appear to respond favourably to spironolactone treatment. In addition, there is recent evidence suggesting that these patients overexpress a key enzyme involved in aldosterone production, the aldosterone synthase, the activity of which appears to relate to its genotypic variation.

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Author notes

  1. This paper has been presented as a debate in the British Hypertension Society Annual Scientific Meeting, Oxford 1999.

Authors and Affiliations

  1. Department of Cardiology, Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff, Wales, CF14 4XN, UK

    P O Lim

  2. Department of Endocrinology, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK

    R T Jung

  3. Department of Clinical Pharmacology and Therapeutics, Hypertension Research Centre, University of Dundee, Dundee, UK

    T M MacDonald

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Correspondence to P O Lim.

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Lim, P., Jung, R. & MacDonald, T. Is aldosterone the missing link in refractory hypertension?: aldosterone-to-renin ratio as a marker of inappropriate aldosterone activity. J Hum Hypertens 16, 153–158 (2002). https://doi.org/10.1038/sj.jhh.1001320

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