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Rates of abnormal aldosterone/renin ratio in African‐origin compared to European‐origin patients: A retrospective study
Author(s) -
Ahmed Khalid S.,
Bogdanet Delia,
Abadi Sorresa,
Dineen RoseMary,
Boran Gerald,
Woods Conor P.,
Behan Lucy Ann,
Sherlock Mark,
Gibney James
Publication year - 2019
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13920
Subject(s) - hyperaldosteronism , aldosterone , medicine , plasma renin activity , relative risk , retrospective cohort study , ethnic origin , renin–angiotensin system , gastroenterology , endocrinology , blood pressure , confidence interval , population , environmental health
Summary Introduction The aldosterone/renin ratio is the initial screening test for primary hyperaldosteronism (PHA), but little data exists regarding ethnic variations in this. Methods Following clinical observation of a high prevalence of abnormal aldosterone/renin ratio (ARR) in patients of African‐origin, we retrospectively reviewed all ARR measurements in a single centre over 10 years. Rates of hypokalaemia, intraventricular septal thickness (IVS, by echocardiography) and adrenal imaging were recorded when available. Results Aldosterone/renin ratio was available in 1473 patients, and abnormal in 374 (25.4%). Abnormal ARR was observed in 305/1349 (22.6%) of European‐origin and 69/124 (55.6%) of African‐origin patients ( P < 0.001). Among those with abnormal ARR, hypokalaemia (<3.5 mmol/L) was documented on at least one occasion in 171/305 (56.1%) European‐origin and 43/69 (62.3%) African‐origin patients ( P = 0.35). Median (range) IVS was 1.57 (0.78‐2.80) cm in African‐origin and 1.20 (0.69‐2.18) cm in European‐origin patients ( P < 0.002); IVS did not correlate with aldosterone or ARR however. Adrenal adenoma was identified in 41/170 (24.1%) of European‐origin and 4/29 (13.7%) African‐origin patients ( P = 0.15), while hyperplasia was identified in 35/170 (20.5%) of European and 8/29 (27.5%) African patients ( P = 0.39). Conclusion In summary, ARR was abnormal in 55.6% of African‐origin patients screened at an Irish hospital. Rates of hypokalaemia were similar between European‐origin and African‐origin patients. These findings have implications for the use of current screening guidelines for ARR in African‐origin patients and also for the mechanistic role of aldosterone in hypertensive complications in African‐origin patients.