Updates on Primary Aldosteronism Screening and Use of Direct Renin

 
Primary aldosteronism (PA) is the most common form of secondary hypertension, caused by hyperactivity in one or both of the adrenal glands that leads to inappropriate aldosterone production. The prevalence of PA among general and resistant hypertensive populations ranges from 5-20%. PA is considered highly treatable and potentially curable. As such, the Endocrine Society guidelines recommend screening for PA in high risk populations using the plasma aldosterone/plasma renin ratio (ARR). It is generally accepted that both the plasma renin and aldosterone levels tend to fall with advancing age and plasma renin decreases more than aldosterone; consequently, the ARR increases in the elderly which supports the need for age-specific ARR cutoffs. Traditionally, renin has been measured by a plasma renin activity (PRA) radioimmunoassay or liquid chromatography tandem mass spectrometry (LC-MS/MS). Direct renin concentration (DRC) immunoassays, also known as plasma renin concentration (PRC), have recently become more popular because of numerous benefits including walk-away automation, shorter turnaround times, and excellent reproducibility compared to PRA. In this webinar, we will review the key differences between PRA and DRC assays and discuss the utility of proposed age-specific ARR cutoffs for PA screening calculated using direct renin measurement.
 
 
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