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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 9/2017

01-09-2017 | Clinical Investigation

Adrenal Vein Sampling for Primary Aldosteronism: A 2-Week Protocol for Withdrawal of Renin-Stimulating Antihypertensives

Authors: Kevin C. Ching, Debbie L. Cohen, Douglas L. Fraker, Scott O. Trerotola

Published in: CardioVascular and Interventional Radiology | Issue 9/2017

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Abstract

Objective

For evaluation of primary aldosteronism, international guidelines recommend a 4–6 week withdrawal of spironolactone, eplerenone, and amiloride prior to adrenal vein sampling (AVS). It is not always feasible to withdraw these drugs in patients with severe hypertension and hypokalemia. We present our experience evaluating the efficacy and clinical outcomes of a 2-week protocol for withdrawal of renin-stimulating antihypertensives prior to AVS.

Design

A single-center retrospective review of all patients who underwent AVS for primary aldosteronism between January 2014 and December 2015.

Patients

32 patients (24 M:8F, mean age 54y) underwent AVS with the 2-week protocol, and 32 held their renin-stimulating antihypertensives for 2 weeks instead of the recommended 4–6 weeks.

Measurements

Plasma renin activity (PRA) was measured immediately before venous sampling to assess for renin suppression (PRA < 0.5 ng/ml/hr). Demographics, antihypertensive medications, plasma aldosterone, plasma renin activity, and outcomes were reviewed.

Results

100% of procedures were diagnostic (selectivity index ≥ 3) and lateralization (lateralization index ≥ 4) was confirmed in 22/32 patients. 19/32 patients had contralateral suppression. PRA confirmed to be suppressed in 30/32 (94%) of patients. Of the 2 patients with unsuppressed renin, 1/2 lateralized diagnosing an aldosterone producing adenoma.

Conclusions

Renin was suppressed in nearly all patients following a 2-week withdrawal of renin-stimulating antihypertensives. Patients who cannot tolerate stopping these medications for 4–6 weeks as recommended by current guidelines may undergo a 2-week withdrawal without affecting the diagnostic outcome of AVS, provided renin suppression is confirmed.

Level of Evidence

Level 4, Case Series.
Literature
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Metadata
Title
Adrenal Vein Sampling for Primary Aldosteronism: A 2-Week Protocol for Withdrawal of Renin-Stimulating Antihypertensives
Authors
Kevin C. Ching
Debbie L. Cohen
Douglas L. Fraker
Scott O. Trerotola
Publication date
01-09-2017
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 9/2017
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-017-1637-x

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