Purpose

Hydralazine, doxazosin, and verapamil are currently recommended by the Endocrine Society as acceptable bridging treatment in those in whom full cessation of antihypertensive medication is infeasible during screening for primary aldosteronism (PA). This is under the assumption that they cause minimal to no effect on the aldosterone-to-renin ratio, the most widely used screening test for PA. However, limited evidence is available regarding the effects of these particular drugs on said ratio.

Methods

In the present study, we retrospectively assessed the changes in aldosterone, renin, and aldosterone-to-renin values in essential hypertensive participants before and after treatment with either hydralazine (n = 26) or doxazosin (n = 20) or verapamil (n = 15). All samples were taken under highly standardized conditions.

Results

Hydralazine resulted in a borderline significant rise in active plasma renin concentration (19 vs 25 mIU/L, p = 0.067) and a significant fall in the aldosterone-to-renin ratio (38 vs 24, p = 0.017). Doxazosin caused declines in both plasma aldosterone concentration (470 vs 330 pmol/L, p = 0.028) and the aldosterone-to-renin ratio (30 vs 20, p = 0.020). With respect to verapamil, we found no statistically significant effect on any of these outcome variables.

Conclusion

We conclude that the assumption that these drugs can be used with little consequence to the aldosterone-to-renin cannot be substantiated. While it is possible that they are indeed the best option when full antihypertensive drug cessation is infeasible, the potential effects of these drugs must still be taken into account when interpreting the aldosterone-to-renin ratio.

中文翻译：

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维拉帕米、肼苯哒嗪、多沙唑嗪对肾素、醛固酮及其比值的影响

目的

内分泌学会目前推荐肼屈嗪、多沙唑嗪和维拉帕米作为可接受的桥接治疗，用于在筛查原发性醛固酮增多症 (PA) 期间无法完全停用抗高血压药物的患者。这是基于它们对醛固酮与肾素比率的影响很小甚至没有影响的假设，醛固酮与肾素比率是最广泛使用的 PA 筛查测试。然而，关于这些特定药物对所述比率的影响的可用证据有限。

方法

在本研究中，我们回顾性评估了原发性高血压参与者在使用肼屈嗪 ( n  = 26) 或多沙唑嗪 ( n  = 20) 或维拉帕米 ( n  = 15). 所有样品均在高度标准化的条件下采集。

结果

肼苯哒嗪导致活性血浆肾素浓度显着升高（19 vs 25 mIU/L，p  = 0.067），醛固酮与肾素比率显着下降（38 vs 24，p  = 0.017）。多沙唑嗪引起血浆醛固酮浓度（470 对 330 pmol/L， p  = 0.028）和醛固酮与肾素比值（30 对 20，p  = 0.020）的下降。关于维拉帕米，我们发现对这些结果变量中的任何一个都没有统计学上的显着影响。

结论

我们得出结论，不能证实使用这些药物对醛固酮转化为肾素几乎没有影响的假设。虽然当完全停用抗高血压药物不可行时，它们确实可能是最佳选择，但在解释醛固酮与肾素比率时仍必须考虑这些药物的潜在影响。