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

Stefan Pilz; Christian Trummer; Nicolas Verheyen; Verena Schwetz; Marlene Pandis; Felix Aberer; Martin R. Grübler; Andreas Meinitzer; Antonia Bachmann; Jakob Voelkl; Ioana Alesutan; Cristiana Catena; Leonardo A. Sechi; Winfried März; Barbara Obermayer-Pietsch; Andreas Tomaschitz

doi:10.1055/a-0604-3249

Hormone and Metabolic Research, Inhaltsverzeichnis

Horm Metab Res 2018; 50(05): 375-382
DOI: 10.1055/a-0604-3249

Endocrine Care

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

Stefan Pilz^*

¹Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

,

Christian Trummer^*

¹Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

,

Nicolas Verheyen

²Department of Cardiology, Medical University of Graz, Graz, Austria

,

Verena Schwetz

¹Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

,

Marlene Pandis

¹Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

,

Felix Aberer

¹Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

,

Martin R. Grübler

³Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland

,

Andreas Meinitzer

⁴Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria

,

Antonia Bachmann

¹Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

,

Jakob Voelkl

⁵Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Berlin, Germany

,

Ioana Alesutan

⁵Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Berlin, Germany

,

Cristiana Catena

⁶Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy

,

Leonardo A. Sechi

⁶Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy

,

Winfried März

⁴Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria

⁷Synlab Academy, Synlab Services GmbH, Mannheim, Germany

,

Barbara Obermayer-Pietsch

¹Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

,

Andreas Tomaschitz

⁸Bad Gleichenberg Clinic, Bad Gleichenberg, Austria

› Institutsangaben

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

Volltext

Referenzen

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