Primary Aldosteronism Screening (ARR)

Aldosterone Input

Renin Input

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

When to Screen for Primary Aldosteronism (PA)

Sustained BP >150/100 mmHg on each of three measurements.

Hypertension resistant to 3 conventional drugs (incl. diuretic) or controlled on ≥4 drugs.

Hypertension with spontaneous or diuretic-induced hypokalemia.

Hypertension with adrenal incidentaloma.

Hypertension with sleep apnea.

Hypertension and family history of early-onset hypertension or cerebrovascular accident <40y.

First-degree relatives of patients with PA.

How it Works

Diagnostic Premise

Primary aldosteronism is characterized by autonomous aldosterone production leading to suppression of renin. Hence, an elevated ratio is pathognomonic if confirmed.

Cutoffs by Assay Type

Aldosterone Units	Renin Assay	Cutoff for Positive Screen
ng/dL (conventional)	Plasma Renin Activity (PRA, ng/mL/h)	> 20 - 30 (with PAC > 15)
ng/dL	Direct Renin Concentration (DRC, mU/L)	> 2.4 - 3.8 (with PAC > 15)
pmol/L (SI units)	PRA (ng/mL/h)	> 550 - 830 (with PAC > 416)
pmol/L	DRC (mU/L)	> 66 - 105 (with PAC > 416)

Last Comprehensive Review: 2026

Recent Journal Updates

Cancer MedicineJul 22, 2026

Analysis of Age, Period and Cohort Trends in Cervical In Situ and Invasive Carcinomas for Assessing the Utility of Screening Approaches—Results From the Saarland Cancer Registry

Clinical Context

We think this might be relevant to the clinical guidance for Aldosterone-to-Renin Ratio (ARR).

JAMAJul 21, 2026

Correction to Primary Composite Outcome in a Trial of Transfusion Strategy

Clinical Context

We think this might be relevant to the clinical guidance for Aldosterone-to-Renin Ratio (ARR).

WHO NewsJul 15, 2026

New WHO guidelines: up to 45% of dementia risk could be prevented or delayed

Clinical Context

We think this has broad domain relevance to Aldosterone-to-Renin Ratio (ARR).

Primary Aldosteronism Screening (ARR)

When to Use

When to Screen for Primary Aldosteronism (PA)

How it Works

Diagnostic Premise

Cutoffs by Assay Type

Clinical Pearls

Medication Interference

Testing Conditions

Next Steps

Positive Screen

The Evidence

Guidelines

The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment

Recent Journal Updates

Primary Aldosteronism Screening (ARR)

When to Use

When to Screen for Primary Aldosteronism (PA)

How it Works

Diagnostic Premise

Cutoffs by Assay Type

Clinical Pearls

Medication Interference

Testing Conditions

Next Steps

Positive Screen

The Evidence

Guidelines

The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment

Recent Journal Updates