Key result
Sertraline and escitalopram significantly reduced the aldosterone/renin ratio over 6 weeks in normotensive depressed men (e.g., sertraline ARR fell from 13.7 to 6.8, P<0.001).
Why the study?
Do selective serotonin reuptake inhibitors (sertraline and escitalopram) reduce the aldosterone/renin ratio in normotensive depressed male patients?
Do selective serotonin reuptake inhibitors (sertraline and escitalopram) reduce the aldosterone/renin ratio in normotensive depressed male patients?
p-value: p=<0.001
SSRI antidepressants (sertraline and escitalopram) significantly reduce the aldosterone-to-renin ratio, potentially increasing the risk of false-negative results when screening for primary aldosteronism.
May raise false-negative PA screening risk in SSRI users; leaves open need for adjusted thresholds.
BACKGROUND: Plasma aldosterone to renin ratio (ARR) is the most popular screening test for primary aldosteronism (PAL). Certain medications are known to cause false-negative or -positive ARRs by affecting renin and aldosterone levels. There are no previously published data on the effects of antidepressants on ARR. METHODS: Normotensive, depressed male patients (n = 26) underwent measurement (seated, midmorning) of plasma aldosterone, direct renin concentration (DRC), renin activity (PRA), electrolytes and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline and after 2 and 6 wk treatment with sertraline (n = 14) or escitalopram (n = 12). RESULTS: For both antidepressants, treatment was associated with rises in aldosterone [sertraline: baseline, mean ± sd, 243 ± 34; 2 wk, 256 ± 33; 6 wk, 267 ± 34 pmol/liter (P < 0.01 by ANOVA); escitalopram, 261 ± 36, 269 ± 38, 282 ± 40 pmol/liter (P < 0.05)], DRC [19.5 ± 2.2, 33.5 ± 2.0, 39.0 ± 2.4 mU/liter (P < 0.001); 24.5 ± 2.4, 34.0 ± 2.7, 42.8 ± 2.4 mU/liter (P < 0.001)], and PRA [2.24 ± 0.21, 2.58 ± 0.26, 4.68 ± 0.42 ng/ml · h (P < 0.001); 4.31 ± 0.22, 5.57 ± 0.36, 6.42 ± 0.53 ng/ml · h (P < 0.001)]. ARR fell significantly whether calculated using DRC [sertraline, 13.7 ± 2.2, 7.5 ± 0.7, 6.8 ± 0.7 (P < 0.001); escitalopram, 11.5 ± 1.9, 8.0 ± 1.1, 6.6 ± 1.0 (P < 0.001)], or PRA [116.6 ± 15.8, 108.4 ± 15.6, 60.4 ± 6.2 (P < 0.001); 61.2 ± 8.1, 50.0 ± 7.7, 45.6 ± 6.0 (P < 0.01)]. CONCLUSION: Selective serotonin reuptake inhibitor antidepressants can significantly reduce ARR and therefore potentially increase the risk of false-negative results when screening for PAL. Further studies in hypertensive patients, including patients with confirmed PAL, are required.
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Ahmed et al. (2011) studied Depression (n=26). Sertraline and Escitalopram vs. Baseline was evaluated on Aldosterone/Renin Ratio (ARR) (p=<0.001). Sertraline and escitalopram significantly reduced the aldosterone/renin ratio over 6 weeks in normotensive depressed men (e.g., sertraline ARR fell from 13.7 to 6.8, P<0.001).
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