{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:40:35Z","timestamp":1791520835969,"version":"4.3.4"},"reference-count":32,"publisher":"The Endocrine Society","issue":"6","license":[{"start":{"date-parts":[[2020,2,18]],"date-time":"2020-02-18T00:00:00Z","timestamp":1581984000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Italian Ministry of Health","award":["RF2011-02352318"],"award-info":[{"award-number":["RF2011-02352318"]}]},{"DOI":"10.13039\/501100003500","name":"University of Padova","doi-asserted-by":"publisher","award":["DOR1625891\/16"],"award-info":[{"award-number":["DOR1625891\/16"]}],"id":[{"id":"10.13039\/501100003500","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003500","name":"University of Padova","doi-asserted-by":"publisher","award":["DOR1670784\/16"],"award-info":[{"award-number":["DOR1670784\/16"]}],"id":[{"id":"10.13039\/501100003500","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003500","name":"University of Padova","doi-asserted-by":"publisher","award":["BIRD163255\/16"],"award-info":[{"award-number":["BIRD163255\/16"]}],"id":[{"id":"10.13039\/501100003500","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>While current guidelines recommend the withdrawal of mineralocorticoid receptor antagonist (MRA) and renin-angiotensin system blockers for the screening and detection of primary aldosteronism (PA), this can worsen hypokalemia and control of high blood pressure (BP) values.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate whether aldosterone\/renin ratio (ARR) values were affected by the MRA canrenone and\/or by canrenone plus olmesartan treatment in patients with PA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Within-patient study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>The European Society of Hypertension center of excellence at the University of Padua.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients<\/jats:title>\n                  <jats:p>Consecutive patients with an unambiguous diagnosis of PA subtyped by adrenal vein sampling.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interventions<\/jats:title>\n                  <jats:p>Patients were treated for 1 month with canrenone (50\u2013100 mg orally), and for an additional month with canrenone plus olmesartan (10\u201320 mg orally). Canrenone and olmesartan were up-titrated over the first 2 weeks until BP values and hypokalemia were controlled. Patients with unilateral PA were adrenalectomized; those with bilateral PA were treated medically.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measures<\/jats:title>\n                  <jats:p>BP, plasma levels of sodium and potassium, renin and aldosterone.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Canrenone neither lowered plasma aldosterone nor increased renin; thus, the high ARR and true positive rate remained unaffected. Addition of the angiotensin type 1 receptor blocker raised renin and slightly lowered aldosterone, which reduced the ARR and increased the false negative rate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>At doses that effectively controlled serum potassium and BP values, canrenone did not preclude an accurate diagnosis in patients with PA. Addition of the angiotensin type 1 receptor blocker olmesartan slightly raised the false negative rate. Hence, MRA did not seem to endanger the accuracy of the diagnosis of PA.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgaa080","type":"journal-article","created":{"date-parts":[[2020,2,18]],"date-time":"2020-02-18T02:21:32Z","timestamp":1581992492000},"page":"2060-2067","source":"Crossref","is-referenced-by-count":50,"title":["Effects of Mineralocorticoid and AT1 Receptor Antagonism on The Aldosterone-Renin Ratio In Primary Aldosteronism\u2014the EMIRA Study"],"prefix":"10.1210","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7963-0931","authenticated-orcid":false,"given":"Gian Paolo","family":"Rossi","sequence":"first","affiliation":[{"name":"Clinica dell\u2019Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Ceolotto","sequence":"additional","affiliation":[{"name":"Clinica dell\u2019Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Rossitto","sequence":"additional","affiliation":[{"name":"Clinica dell\u2019Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy"},{"name":"Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Maiolino","sequence":"additional","affiliation":[{"name":"Clinica dell\u2019Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Cesari","sequence":"additional","affiliation":[{"name":"Clinica dell\u2019Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa Maria","family":"Seccia","sequence":"additional","affiliation":[{"name":"Clinica dell\u2019Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2020,2,18]]},"reference":[{"issue":"11","key":"2021122105015188500_CIT0001","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1097\/HJH.0000000000001088","article-title":"Guidelines for primary aldosteronism: uptake by primary care physicians in Europe","volume":"34","author":"Mulatero","year":"2016","journal-title":"J Hypertens."},{"issue":"14","key":"2021122105015188500_CIT0002","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1016\/j.jacc.2017.01.052","article-title":"Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice","volume":"69","author":"Monticone","year":"2017","journal-title":"J Am Coll Cardiol."},{"issue":"11","key":"2021122105015188500_CIT0003","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1016\/j.jacc.2006.07.059","article-title":"A prospective study of the prevalence of primary aldosteronism in 1125 hypertensive patients","volume":"48","author":"Rossi","year":"2006","journal-title":"J Am Coll Cardiol."},{"issue":"12","key":"2021122105015188500_CIT0004","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.1097\/HJH.0000000000001961","article-title":"2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH\/ESC Task Force for the Management of Arterial Hypertension","volume":"36","author":"Williams","year":"2018","journal-title":"J Hypertens."},{"key":"2021122105015188500_CIT0005","doi-asserted-by":"crossref","first-page":"32103","DOI":"10.1038\/srep32103","article-title":"Long term outcome of aldosteronism after target treatments","volume":"6","author":"Wu","year":"2016","journal-title":"Sci Rep."},{"issue":"1","key":"2021122105015188500_CIT0006","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S2213-8587(17)30367-4","article-title":"Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study","volume":"6","author":"Hundemer","year":"2018","journal-title":"Lancet Diabetes Endocrinol."},{"issue":"3","key":"2021122105015188500_CIT0007","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1161\/HYPERTENSIONAHA.119.12935","article-title":"Primary Aldosteronism","volume":"74","author":"Funder","year":"2019","journal-title":"Hypertension."},{"issue":"5","key":"2021122105015188500_CIT0008","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1210\/jc.2015-4061","article-title":"The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline","volume":"101","author":"Funder","year":"2016","journal-title":"J Clin Endocrinol Metab."},{"issue":"9","key":"2021122105015188500_CIT0009","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.tem.2013.05.003","article-title":"Primary aldosteronism: emerging trends","volume":"24","author":"Galati","year":"2013","journal-title":"Trends Endocrinol Metab."},{"issue":"6","key":"2021122105015188500_CIT0010","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1161\/01.HYP.0000038478.59760.41","article-title":"Drug effects on aldosterone\/plasma renin activity ratio in primary aldosteronism","volume":"40","author":"Mulatero","year":"2002","journal-title":"Hypertension."},{"issue":"4","key":"2021122105015188500_CIT0011","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/S0272-6386(01)80117-7","article-title":"Screening for primary aldosteronism without discontinuing hypertensive medications: plasma aldosterone-renin ratio","volume":"37","author":"Gallay","year":"2001","journal-title":"Am J Kidney Dis."},{"issue":"8","key":"2021122105015188500_CIT0012","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1161\/CIRCULATIONAHA.118.033597","article-title":"Primary aldosteronism","volume":"138","author":"Byrd","year":"2018","journal-title":"Circulation."},{"issue":"1","key":"2021122105015188500_CIT0013","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1309\/8EXCCM6YR1THUBAF","article-title":"Toward complete and accurate reporting of studies of diagnostic accuracy. 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