Aldosterone/Plasma Renin Activity Ratio

Optimal Result: 0.9 - 28.9 Ratio.

The aldosterone-renin ratio (ARR), also known as the aldosterone plasma renin activity (PRA) ratio, is a critical diagnostic tool used in the evaluation of primary aldosteronism, a condition characterized by excessive production of the hormone aldosterone by the adrenal glands.

Aldosterone plays a significant role in regulating blood pressure by controlling sodium and potassium levels in the blood, and its overproduction can lead to hypertension (high blood pressure) and hypokalemia (when the amount of potassium in your blood is too low).

The ARR test measures the levels of aldosterone and renin, an enzyme essential for the production of angiotensin II which stimulates aldosterone release, in the blood.

A high ARR suggests that aldosterone production is not appropriately regulated by renin, which is indicative of primary aldosteronism.

The ARR compares the amount of aldosterone to that of renin, and the resulting number – a ratio – is then compared with a “cutoff” value currently set at 30 (or 750 when measurements are expressed in SI units). Below this value, the result is considered normal. Above this value, primary aldosteronism is suspected.

What is Measured?

Testing laboratories measure the ratio of aldosterone to renin. The test not only shows the level of each hormone, it determines the relative amount of aldosterone to renin present in the blood. In healthy individuals, these levels rise and fall together. In those who have primary aldosteronism, aldosterone is high while renin is low — renin is said to be “suppressed.” The higher the ARR result, the more likely a person has primary aldosteronism.

What Results Mean:

While measuring aldosterone is fairly straightforward, renin can be evaluated through different methods. Until recently, Plasma Renin Activity (PRA) was the most common way to measure “active renin.” It is now frequently replaced with a faster method, Direct Renin Concentration (DRC). Unfortunately, this method may not be optimal to measure low levels of renin, which is exactly what must be ascertained with primary aldosteronism.

ARR Accuracy:

To be accurate, tests must be sensitive (they must detect the condition in people who have it), and specific (they must rule out the condition in people who don’t have it).  Highly sensitive tests are usually less specific: they trigger “false-positives,” which means some patients are told they have the condition while they don’t. Highly specific tests tend to have lower sensitivity: they trigger “false-negatives,” which means some patients are told they do not have the condition while they do.

ARRs are considered sensitive tests, and thus lack specificity. Up to 50% of elevated ARRs may be “false-positives.” To remediate this risk, PA patients must undergo confirmatory testing to validate or rule out false positive ARR results.

Determining what is considered an abnormal result is as important as the accuracy of the test. ARR cutoff values are somewhat arbitrary, and based on current understanding of excess aldosterone. The lower the cutoff value, the more people are diagnosed, and vice versa.

Note: The test must be interpreted carefully, considering factors that can affect renin or aldosterone levels, such as medications, posture, and sodium intake. Consequently, the ARR is often used in conjunction with other clinical assessments and diagnostic procedures to confirm the diagnosis.

What does it mean if your Aldosterone/Plasma Renin Activity Ratio result is too high?

A high aldosterone-renin ratio (ARR) is a key indicator used to screen for primary aldosteronism, also known as Conn's syndrome, which is a type of hormonal disorder that leads to hypertension. Primary aldosteronism is characterized by the overproduction of aldosterone by the adrenal glands, independent of the renin-angiotensin system, which usually regulates aldosterone levels.

When the ARR is elevated, it means that the aldosterone level is high relative to the renin level. This imbalance can lead to a variety of symptoms and complications, the most notable of which is high blood pressure that may be resistant to conventional antihypertensive treatments. Other possible symptoms include muscle weakness, fatigue, and excessive thirst or urination, due to the effects of aldosterone on electrolyte balance, particularly the retention of sodium and excretion of potassium.

It's important to note that while a high ARR is suggestive of primary aldosteronism, it is not conclusive on its own. Other conditions can also cause an increased ratio, such as some forms of secondary hypertension, where aldosterone production is inappropriately high for the level of renin but not autonomous. Additionally, factors such as potassium levels, medications (like beta-blockers, diuretics, or angiotensin-converting enzyme inhibitors), and even posture at the time of blood draw can affect the levels of aldosterone and renin, thus influencing the ratio.

Therefore, a high ARR typically prompts further confirmatory testing, such as salt-loading tests or adrenal vein sampling, to confirm the diagnosis of primary aldosteronism and to determine the appropriate treatment, which might include surgical removal of the affected adrenal gland or specific medication to block the effects of aldosterone.

What does it mean if your Aldosterone/Plasma Renin Activity Ratio result is too low?

A low aldosterone-renin ratio (ARR) can indicate different physiological conditions, depending on the absolute levels of aldosterone and renin. This ratio is most commonly used to screen for primary aldosteronism when the ratio is elevated, but a low ratio may also be clinically significant.

If both aldosterone and renin levels are low, it might suggest conditions such as adrenal insufficiency (Addison's disease), where the adrenal glands do not produce sufficient amounts of aldosterone, or a state of salt-wasting where there is an excessive loss of sodium from the body.

Conversely, if aldosterone levels are low but renin levels are high, it can be indicative of conditions such as secondary aldosteronism, which can occur in response to heart failure, liver cirrhosis, or renal artery stenosis. In these conditions, the renin-angiotensin-aldosterone system is activated due to perceived low blood volume or renal perfusion, and while renin levels increase, the adrenal glands do not respond with an appropriate increase in aldosterone.

A low ARR may also be found in patients who are being effectively treated for primary aldosteronism with medications like aldosterone antagonists.

Interpretation of a low aldosterone PRA ratio should always be done with careful consideration of the patient's clinical history, presentation, and other laboratory findings to determine the underlying cause and appropriate management.

Frequently asked questions

Unlock Your Health Journey with! Ever wished for a one-stop digital health haven for all your lab tests? Look no further! is your personalized health dashboard, bringing together test reports from any lab. Say goodbye to scattered results—organize and centralize your lab data effortlessly. Dive into the details of each biomarker and gain insights into the meaning behind your medical test data.

Join the community of thousands who've transformed the way they understand their lab results. Experience the joy of having all your lab data neatly organized, regardless of where or when the tests were done.

For our professional users, is a game-changer. Revel in the intuitive tools that not only streamline analysis but also save valuable time when delving into your client's lab report history. It's not just a dashboard; it's your gateway to a smarter, more informed health journey! personal account provides in-depth research on 4000+ biomarkers, including information and suggestions for test panels such as, but not limited to:

  • The GI Effects® Comprehensive Stool Profile,
  • GI-MAP,
  • The NutrEval FMV®,
  • The ION Profile,
  • Amino Acids Profile,
  • Dried Urine Test for Comprehensive Hormones (DUTCH),
  • Organic Acids Test,
  • Organix Comprehensive Profile,
  • Toxic Metals,
  • Complete Blood Count (CBC),
  • Metabolic panel,
  • Thyroid panel,
  • Lipid Panel,
  • Urinalysis,
  • And many, many more.

You can combine all test reports inside your Healthmatters account and keep them in one place. It gives you an excellent overview of all your health data. Once you retest, you can add new results and compare them.

If you are still determining whether Healthmatters support your lab results, the rule is that if you can test it, you can upload it to Healthmatters.

While we do talk about popular labs, we welcome reports from lots of other places too. It's as simple as this: if you can get a test done, you can upload it to Healthmatters. We can interpret results from any lab out there. If laboratories can analyze it, we can interpret it.

Still on the hunt for a specific biomarker? Just tell us, and we'll add it to our database. Anything from blood, urine, saliva, or stool can be uploaded, understood, and tracked with your Healthmatters account!

There are two ways to add your test reports to your account. One option is to input the data using the data entry forms. The other method is to utilize our "Data entry service."

Our data entry forms offer an easy, fast, and free way for you to input the reports yourself. Self-entry allows you to add an unlimited number of reports at no cost. We make the self-entry process user-friendly, providing dozens of templates that pre-populate the most popular laboratory panels and offering instant feedback on entered values.

For those who prefer assistance, we offer a "Data entry service" to help you input your data. Simply attach an image or file of your lab test results, and a qualified team member from our data entry team will add the results for you. We support various file types, including PDFs, JPGs, or Excel. This service is particularly useful if you have many reports to upload or if you're too busy to handle the data entry yourself.

Our special data entry service makes it easy to add your results to your private dashboard. Just attach an image or a file of your lab test results, and our skilled data entry team will do the work for you. It's all done by humans, ensuring that your data is entered accurately and with personal care for each client.

Depending on your account, the data entry service can be included for free or come at an additional cost of $15 per report.

For users on the Complete monthly plan, the first report is entered free of charge, and each additional report incurs a fee of $15.

Unlimited account holders enjoy the entry of ten reports without charge. Subsequent reports are subject to a $15 fee per report.

Additionally, users on the Complete plan can upgrade to a yearly subscription from the account settings. The annual subscription includes a data entry service for five reports.

The Unlimited plan is a one-time purchase for $250, and it covers your account for a lifetime with no additional payments.

For the Complete plan, the cost is $15 per month. You have the flexibility to cancel it anytime through your account settings, ensuring no further payments. To avoid charges, remember to cancel at least a day before the renewal date. Once canceled, the subscription remains active until the end of the current billing cycle.

Additionally, you can upgrade to the yearly Advanced plan from within your account. The annual cost is $79, and it comes with a data entry service for five reports.

You can always upgrade to a lifetime version with a prorated price from a monthly or yearly subscription.

Simply log in and navigate to your account settings to cancel your subscription. Scroll down to locate the 'Cancel' button at the bottom of the page. Ensure you cancel at least one day before the renewal date to prevent any charges. Once cancellation is requested, the subscription remains active until the conclusion of the current billing cycle.

Unlocking the insights from your lab tests has never been this intuitive! We've crafted multiple ways for you to navigate your data, whether you're glancing at a single report or delving into a treasure trove of testing data.

1. Graph View:

Dive into a visual journey with our biomarker graphs, showcasing over 40 data points. Combining years of results unveils trends, empowering you to make informed decisions. Our visualization tools make it a breeze to compare and understand changes over time, even if your results are from different labs. A search function and filters simplify the exploration of extensive data, allowing you to focus on what needs attention.

2. All Tests View

Get a quick grasp of your test reports in minutes! Explore neatly organized reports on a timeline, highlighting crucial details like dates, critical results, and lab/panel names. Each report opens up to reveal in-depth descriptions and additional recommendations for each biomarker. The history of previous results is just a click away, and you can download a comprehensive report for deeper insights. Color-coded and user-friendly, it's designed for easy reading, understanding, and navigation.

3. Table View:

For a holistic view of all biomarkers side by side, our table view is your go-to. Results are neatly displayed in a categorized and dated table, ideal for those with an extensive test history. Utilize sorting, filters, and color-coding to enhance your analysis and gain extra insights.

Experience the power of clear, organized data visualization with — your key to understanding and taking charge of your health journey!

Yes, you can download information from your account. We can compile your labs into a CSV file. To download all your labs, you can go to Account Settings, and at the bottom of the page, you will find a link to download your information.

Yes, you can print your report. To do so, navigate to "All tests" and open the report you wish to print. You'll find a print button in the right corner of the report. Click on it, and your browser's print window will open. If you prefer to print in a bigger typeface, adjust the scale using the print window settings.

A personal account is all about keeping your own lab test results in check. It's just for you and your personal use.

The professional or business account is designed for health professionals who wish to track and organize their clients' laboratory results.

Use promo code to save 10% off any plan.

We implement proven measures to keep your data safe.

At HealthMatters, we're committed to maintaining the security and confidentiality of your personal information. We've put industry-leading security standards in place to help protect against the loss, misuse, or alteration of the information under our control. We use procedural, physical, and electronic security methods designed to prevent unauthorized people from getting access to this information. Our internal code of conduct adds additional privacy protection. All data is backed up multiple times a day and encrypted using SSL certificates. See our Privacy Policy for more details.