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2016 ; 101
(11
): 3989-3996
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Dietary Sodium Restriction Increases the Risk of Misinterpreting Mild Cases of
Primary Aldosteronism
#MMPMID27428770
Baudrand R
; Guarda FJ
; Torrey J
; Williams G
; Vaidya A
J Clin Endocrinol Metab
2016[Nov]; 101
(11
): 3989-3996
PMID27428770
show ga
CONTEXT: The aldosterone to renin ratio (ARR) is recommended to screen for
primary aldosteronism (PA). OBJECTIVE: To evaluate whether dietary sodium
restriction results in misinterpretation of PA screening. PARTICIPANTS: Untreated
hypertensives with ARR more than 20 on a high dietary sodium intake (HS) were
also evaluated on a low dietary sodium intake (LS) (n = 241). Positive screening
for PA was defined as: plasma renin activity (PRA) less than or equal to 1.0
ng/mL · h with serum aldosterone more than or equal to 6 ng/dL. PA was confirmed
by a 24-hour urinary aldosterone excretion more than or equal to 12 mcg with
urinary sodium more than 200 mmol. RESULTS: Only 33% (79/241) of participants
with an ARR more than 20 had a positive PA screen on HS. On LS, 56% (44/79) of
these participants no longer met criteria for positive PA screening. When
compared with participants with positive PA screening on both diets, participants
with a positive screen on HS but negative on LS exhibited a significantly higher
PRA on both diets. Remarkably, of the 48/79 participants who had PA confirmed,
52% had negative PA screening on LS. The distinguishing feature of these
participants with "discordant" screening results was a larger rise in PRA on LS
resulting in normalization of the ARR and higher Caucasian race prevalence.
CONCLUSIONS: Sodium restriction is recommended in hypertension; however, it can
significantly raise PRA, normalize the ARR, and result in false interpretation of
PA screening. Milder phenotypes of PA, where PRA is not as suppressed, are most
susceptible to dietary sodium influences on renin and ARR. Optimal screening for
PA should occur under conditions of HS.
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