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Licensed Unlicensed Requires Authentication Published by De Gruyter August 4, 2022

Chinese normotensive and essential hypertensive reference intervals for plasma aldosterone and renin activity by liquid chromatography-tandem mass spectrometry

  • Jenny Yeuk-Ki Cheng EMAIL logo , Felix Chi-Kin Wong , Edith Wing-Kar Chow , Wendy Wan-Hang Lau , Kitty Kit-Ting Cheung , Timothy Hua-Tse Cheng , Teresa Kam-Chi Tsui , Alan Shek-Lun Chan , Clara Wai-Shan Lo and Chung-Shun Ho



The renin-angiotensin-aldosterone system (RAAS) regulates blood pressure. Plasma renin activities (PRA) and plasma aldosterone concentrations (PAC) are biomarkers related to RAAS. Liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based measurements for PRA and PAC have become popular. Method-specific reference intervals (RIs) are required.


Routine PRA and PAC services in a Hong Kong teaching hospital were based on LC-MS/MS methods. PRA and PAC RIs were developed for normotensive subjects and essential hypertensive (EH) patients. Healthy volunteers were recruited to establish normotensive RIs. PRA and PAC results of hypertensive patients with urine aldosterone tests for primary aldosteronism (PA) screening were retrieved from the laboratory information system. Patients without PA were included. Patients with secondary hypertension and patients on medications affecting the RAAS were excluded. The central 95% RIs were established based on the recommendations of the Clinical and Laboratory Standards Institute guideline C28-A3.


PRA and PAC of 170 normotensive volunteers and 362 EH patients were analysed. There was no sex-specific difference in PRA and PAC for normotensive and EH reference subjects. Differences for PRA and PAC were noted between normotensive subjects aged below 45 and their older counterparts. However, such a difference was only identified for PRA but not PAC in EH patients. Age-specific RIs were established accordingly.


This study presented age-specific LC-MS/MS RIs of PRA and PAC for both normotensive and EH populations for local Chinese in Hong Kong.

Corresponding author: Jenny Yeuk-Ki Cheng, Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30–32 Ngan Shing Street, Statin, NT, Hong Kong, Phone: +(852) 5569 9723, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The study has been approved by The Chinese University of Hong Kong–New Territories East Cluster Clinical Research Ethics Committee.


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Received: 2022-04-04
Accepted: 2022-07-13
Published Online: 2022-08-04
Published in Print: 2022-09-27

© 2022 Walter de Gruyter GmbH, Berlin/Boston

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