Aldosterone-renin ratio elevated — primary aldosteronism research
The aldosterone-renin ratio (ARR) is the screening test for primary aldosteronism — a condition where the adrenals autonomously produce excess aldosterone, driving hypertension and hypokalaemia (low potassium). Primary aldosteronism is now estimated in research literature to cause 5-13% of hypertension cases (much higher than the historical 1% estimate), and is particularly common in resistant hypertension. An ARR above ~30 (when aldosterone is in ng/dL and renin in ng/mL/h) is the standard screening threshold; confirmatory tests (saline suppression, captopril challenge) follow if positive.
Reference ranges
| Plasma aldosterone — supine reference | < 10 ng/dL |
| Plasma renin activity | 0.5 – 4.0 ng/mL/h |
| ARR — screening threshold | > 30 |
| ARR — alternative units | > 750 pmol/L per ng/L |
What this marker measures
Aldosterone is the primary mineralocorticoid produced by the adrenal zona glomerulosa; it stimulates renal sodium reabsorption (raising blood pressure) and potassium excretion. Renin is the kidney enzyme that initiates the renin-angiotensin-aldosterone system (RAAS). In healthy individuals, aldosterone and renin move together — high aldosterone reflects appropriate RAAS activation. In primary aldosteronism, aldosterone rises while renin is suppressed by the resulting hypertension and sodium retention; the ratio captures this discordance.
Why might it be elevated?
- ·Primary aldosteronism (Conn syndrome, bilateral adrenal hyperplasia)
- ·Adrenal adenoma producing aldosterone
- ·Familial hyperaldosteronism (rare genetic forms)
- ·Renal artery stenosis (also raises aldosterone but not the ratio — renin is also high)
Why might it be low?
- ·Normal physiology
- ·Addison disease (low aldosterone with high renin)
- ·Renal salt wasting
- ·Heparin therapy (suppresses aldosterone)
FAQ
Why is this test important for hypertension?+
Primary aldosteronism is treatable (mineralocorticoid receptor antagonist or surgical adrenalectomy in adenomas) and produces dramatic blood pressure improvement when correctly identified. It's frequently missed because routine hypertension workup doesn't include ARR — the literature has been pushing for broader screening, especially in resistant hypertension or hypertension with hypokalaemia.
What about medications interfering with ARR?+
Beta-blockers, ACE inhibitors, ARBs, mineralocorticoid receptor antagonists, and diuretics all affect aldosterone or renin and can produce false negatives or positives. Standard pre-test medication washout is challenging — discuss with the testing endocrinologist.
This page describes biomarker research and reference ranges for self-tracking and research-context discussion only. It is not medical advice, not a diagnosis, and not a substitute for a qualified physician. Take any concerns about your health to a clinician.
Have your own panel? Read it next to the standard reference ranges with our free analyse tool.
Analyse my blood work →- BiomarkerSodium 132 mmol/L
Serum sodium at 132 mmol/L sits below the standard reference range. Causes range from over-hydration to medication effects to hormonal dysregulation; assessment depends on volume status.
- BiomarkerPotassium 5.2 mmol/L
Serum potassium at 5.2 mmol/L is just above the standard reference range. Most often haemolysis artefact; persistent elevation merits cardiac and renal workup.