When should ARR be measured?

ARR is the recommended screening test for primary hyperaldosteronism in: hypertension with spontaneous or diuretic-induced hypokalemia, resistant hypertension (3 or more medications), hypertension with adrenal incidentaloma, and onset of hypertension before age 40.

What medications affect the ARR?

Spironolactone and eplerenone significantly interfere (withdraw 4 weeks). Beta-blockers suppress renin (false elevation of ARR). ACE inhibitors and ARBs increase renin (may suppress ARR). Ideally use only calcium channel blockers and alpha-blockers before testing.

What are confirmatory tests for primary hyperaldosteronism?

Confirmatory tests include the fludrocortisone suppression test (gold standard), oral sodium loading test (24h urine aldosterone), saline infusion test, and captopril challenge test. CT adrenal imaging and adrenal vein sampling follow confirmation.

Aldosterone-to-Renin Ratio (ARR)

Calculate ARR for primary hyperaldosteronism screening: ARR = aldosterone (ng/dL) / renin (ng/mL/hr). ARR above 30 with aldosterone above 15 ng/dL = suspicious, requires confirmatory testing.

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Frequently Asked Questions

When should ARR be measured?

What medications affect the ARR?

What are confirmatory tests for primary hyperaldosteronism?