Dear Expert

1-what ratio would you use to diagnose primary hyperaldosteronism if renin is reported as renin concentration in ng/L and aldosterone is reported in pmol/L (ratio of aldosterone/renin)

2-would you think that the presence of CKD may change the interpretation of the result for renin/aldosterone to diagnose primary hyperaldosteronism, assuming pt is not on Spironolactone?

3-How high would you go on spironolactone dose in pts with primary hyperaldosteronism to control their blood pressure and what is your second chose (on top of Spironolactone) for lowering blood pressure in this pt population?

Thanks