The following is a summary of “Effect of Oral Contraception on Screening Tests for Primary Aldosteronism: A 10-Year Longitudinal Study,” published in the July 2023 issue of Endocrinology & Metabolism by Yang, et al.
For a study, researchers sought to investigate the impact of oral contraception (OC) on the screening test for primary aldosteronism (PA). In the retrospective cohort study, data from female participants aged 17 years (N = 484) and/or 27 years (N = 486) from the Raine Study, a population-based birth cohort, were analyzed. Blood pressure (BP) measurements, blood samples, and information about OC use were considered.
In OC users, aldosterone concentration was significantly higher at 17 years (median 486 pmol/L vs 347 pmol/L, P < 0.001). Renin concentration was significantly lower in OC users at both 17 years (13.4 mU/L vs 20.6 mU/L) and 27 years (9.2 mU/L vs 11.8 mU/L), resulting in a significantly higher aldosterone to renin ratio (ARR) in OC users compared to nonusers at both 17 years (31.5 vs 18.3) and 27 years (27.3 vs 21.1). The proportion of participants with ARR > 70 pmol/mU (current threshold for PA detection) was significantly higher in OC users at both 17 years (12.6% vs 2.1%) and 27 years (6.4% vs 0.4%), despite having comparable BP to those with ARR < 70. OC use at any age eliminated the relationship between ARR and BP observed in nonusers.
The use of oral contraception can lead to an increase in the aldosterone to renin ratio and result in a false positive PA screening outcome. Until more reliable criteria for PA screening in OC users are established, alternative contraception methods should be considered during screening.