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JAMA Diagnostic Test Interpretation

Aldosterone-Renin Ratio in the Assessment of Primary Aldosteronism

Bharat Kumar, MD
Melissa Swee, MD

A middle-aged patient with diabetes and hypertension presented to his primary care physician for regular health assessment. His blood pressure was 183/116 mm Hg despite taking lisinopril (40 mg/d) and verapamil (180 mg/d). He had previously taken hydrochlorothiazide, which was discontinued due to hypokalemia approximately 1 month ago, as well as atenolol, which was stopped 2 months earlier. As part of the workup for secondary hypertension, plasma aldosterone concentration and plasma renin activity were measured (Table).

Measurement Patient’s Value Reference Range
Serum potassium, mmol/L
3.7
3.7-4.8
Serum creatinine, mmol/L
0.88

Plasma aldosterone concentration (PAC), ng/dL
22.8
<21
Plasma renin activity (PRA), ng/mL∙h
0.32
2.9-10.8
Aldosterone-renin ratio (ARR, or PAC/PRA ratio), ng/dL per ng/mL∙h 71.25 0.9-28.9

See the full article for an explanation and discussion.

Author Affiliations: Dr Kumar (bharat.kumar@uky.edu) is affiliated with the Department of Internal Medicine, University of Kentucky, Lexington. Dr Swee is affiliated with the Department of Internal Medicine, University of Nebraska, Omaha.