Key result
Canrenone treatment in patients with primary aldosteronism progressively increased the rate of false negative screening tests, reaching 72.5% after 7 to 12 months of therapy.
Why the study?
Guidelines recommend avoiding mineralocorticoid receptor antagonists during primary aldosteronism screening, but a recent report suggested treatment could continue without significantly affecting screening results.
Does mineralocorticoid receptor antagonist treatment affect the aldosterone to renin ratio and screening accuracy in patients with primary aldosteronism?
Cohort (n=121)
Does mineralocorticoid receptor antagonist treatment affect the aldosterone to renin ratio and screening accuracy in patients with primary aldosteronism?
Mineralocorticoid receptor antagonists significantly alter the aldosterone to renin ratio, leading to high false-negative rates in primary aldosteronism screening, supporting guidelines to avoid their use prior to testing.
CONTEXT: Although current international guidelines recommend to avoid mineralocortcoid receptor antagonists in patients undergoing screening test for primary aldosteronism, a recent report suggested that mineralocorticoid receptor antagonist treatment can be continued without significant influence on screening results. OBJECTIVE: We aimed to evaluate the effect of mineralocorticoid receptor antagonists on the aldosterone to renin ratio in patients with primary aldosteronism. METHODS: We prospectively enrolled 121 patients with confirmed primary aldosteronism who started mineralocorticoid receptor antagonist (canrenone) treatment. Eighteen patients (11 with unilateral and 7 with bilateral primary aldosteronism) constituted the short-term study cohort and underwent aldosterone, renin, and potassium measurement after 2 and 8 weeks of canrenone therapy. The long-term cohort comprised 102 patients (16 with unilateral and 67 with bilateral primary aldosteronism, and 19 with undetermined subtype) who underwent hormonal and biochemical re-assessment after 2 to 12 months of canrenone therapy. RESULTS: Renin and potassium levels showed a significant increase, and the aldosterone to renin ratio displayed a significant reduction compared with baseline after both a short- and long-term treatment. These effects were progressively more evident with higher doses of canrenone and after longer periods of treatment. We demonstrated that canrenone exerted a deep impact on the diagnostic accuracy of the screening test for primary aldosteronism: the rate of false negative tests was raised to 16.7%, 38.9%, 54.5%, and 72.5% after 2 weeks, 8 weeks, 2 to 6 months, and 7 to 12 months of mineralocorticoid receptor antagonist treatment, respectively. CONCLUSION: Mineralocorticoid receptor antagonists should be avoided in patients with hypertension before measurement of renin and aldosterone for screening of primary aldosteronism.
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Pecori et al. (2021) conducted a cohort in Primary aldosteronism (n=121). Canrenone (mineralocorticoid receptor antagonist) vs. Baseline was evaluated on Aldosterone to renin ratio and rate of false negative screening tests. Canrenone treatment in patients with primary aldosteronism progressively increased the rate of false negative screening tests, reaching 72.5% after 7 to 12 months of therapy.
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