🫀 Blood Pressure That Will Not Come Down
For everyone · 9 markers · $160.65
with code CAMERON $178.50
Anyone under about 45 with high blood pressure, anyone whose pressure needs three or more drugs to control, and anyone whose potassium has been running low without an obvious reason.
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All 9 markers load into your cart in one click. No doctor's visit, drawn at any Quest location in the US, results by email in about two weeks. Code CAMERON applies automatically.
Add all 9 markers — $160.65 → Open the full Bloodwork Vault →Why this panel
Most high blood pressure has no single findable cause. A minority does, and that minority is concentrated in exactly the people this panel is for: young, resistant to treatment, or spilling potassium. The commonest of the findable causes is an adrenal gland producing too much aldosterone, and it is systematically under-screened — which matters because it is treated differently from ordinary hypertension and because it damages the heart and kidney faster at the same blood pressure.
What this panel can settle, and by what logic
Nine markers built around one screening question and three consequences, for the specific reader whose pressure is high young, high on three drugs, or high with a low potassium.
- Aldosterone read beside the potassium on the Comprehensive Metabolic Panel (CMP) is the reason this panel exists. Primary aldosteronism is the commonest identifiable cause of hypertension and it is treated differently from the ordinary kind. The screening test is the aldosterone-to-renin ratio, whose performance has been measured directly in specialist Hung 2021 and primary care Ariens 2022 populations, and whose components vary enough between draws that a single value is a screen rather than an answer Ng 2022.
- Cystatin C with eGFR is here because creatinine lies about muscular people. Creatinine-based and cystatin-based filtration estimates disagree systematically, and the discordance is largest at the extremes of muscle mass Wang 2023. Getting this wrong turns a normal kidney into a reason to stop treatment.
- Urinalysis, Routine finds protein, which is the earliest evidence the pressure is causing damage. Albuminuria is the marker with the clearest prognostic value in this setting and the testing landscape for it has moved recently Beernink 2025.
- Uric Acid changes which drug makes sense. Losartan is uricosuric through direct inhibition of the URAT1 transporter, and this is a property of losartan specifically rather than of the ARB class Hamada 2008. If gout is in the picture, that single fact can decide the prescription.
- HbA1c (Hemoglobin A1c) and the Lipid Panel (Cholesterol, HDL, LDL, Triglycerides) place the pressure inside the rest of the risk, and hyperuricemia clusters with the same metabolic picture rather than standing apart from it Yanai 2021.
- TSH (Thyroid-Stimulating Hormone) excludes the thyroid cause for nine dollars.
What it cannot settle, and what would
It cannot complete the aldosterone-to-renin ratio, because renin is not in this catalog. That is the honest limit of this page. What an Aldosterone plus a potassium can do is tell you whether the question is worth taking further: a high or high-normal aldosterone beside a low or low-normal potassium is the pattern that justifies asking a clinician for plasma renin and completing the ratio Hung 2021. Ordering the renin is the next step, not a repeat of this panel.
It cannot measure your blood pressure. A validated home monitor used properly twice a day for a week is worth more than everything on this requisition and costs less than one of the markers. Nothing here substitutes for it.
It cannot be interpreted cleanly while you are on treatment, and you should not come off treatment to fix that. Several antihypertensives move aldosterone and renin in opposite directions, which is why the ratio has been studied specifically before drug washout Ariens 2022. Write your medications on the requisition and let whoever reads it account for them.
And it cannot find a narrowed renal artery or an adrenal nodule. Both are imaging, and both are what a suggestive screen leads to Ng 2022.
Draw conditions that decide whether the money is wasted
Posture is the condition people do not know about, and it is the one that invalidates the Aldosterone.
- Sit upright for at least 15 minutes before the draw. Aldosterone is posture-dependent and a recumbent sample is not comparable to a seated one, which is part of why the ratio varies so much between measurements Ng 2022.
- Morning, 8 to 10am, fasted 9 to 12 hours. Aldosterone follows the same daily rhythm as cortisol.
- No licorice for two weeks. Glycyrrhizin blocks the enzyme that protects the mineralocorticoid receptor from cortisol and produces a convincing imitation of aldosterone excess, complete with a low potassium.
- Do not stop any blood pressure medication for this test on your own. The decision belongs with whoever prescribed it Ariens 2022. Record every drug, including anti-inflammatories and any potassium supplement.
- Collect the urine as a first or second morning sample so the protein result is comparable with the ones that follow it Beernink 2025.
How you would know it answered your question, and what each pattern means next
Four patterns, and what confirms or refutes each.
- Raised or high-normal Aldosterone with potassium at or below the bottom of the Comprehensive Metabolic Panel (CMP) range: ask for plasma renin. A suppressed renin with this aldosterone is the positive screen, and confirmatory testing follows Hung 2021.
- Normal Aldosterone with a normal potassium: primary aldosteronism is much less likely, though not excluded on medication Ng 2022. The work moves to home measurement, sodium, alcohol, weight and sleep.
- Protein on the Urinalysis, Routine or a reduced Cystatin C with eGFR filtration rate: the kidney becomes the priority, and a falling protein is what tells you treatment is working Beernink 2025.
- Raised Uric Acid with a history of gout: losartan specifically lowers urate while controlling pressure, which makes the drug choice do two jobs Hamada 2008. Recheck urate 8 weeks after any change.
Sources read for these sections
- Hung A, et al. Performance of the Aldosterone to Renin Ratio as a Screening Test for Primary Aldosteronism. Journal of Clinical Endocrinology and Metabolism 2021 · PMID 34008000
- Ng E, et al. Aldosterone, Renin, and Aldosterone-to-Renin Ratio Variability in Screening for Primary Aldosteronism. Journal of Clinical Endocrinology and Metabolism 2022 · PMID 36179243
- Ariens J, et al. Performance of the aldosterone-to-renin ratio as a screening test for primary aldosteronism in primary care. Endocrine 2022 · PMID 35622194
- Hamada T. Uricosuric action of losartan via the inhibition of urate transporter 1 (URAT 1) in hypertensive patients.. Am J Hypertens 2008 · PMID 18670416
- Wang Y, et al. Discordance Between Creatinine-Based and Cystatin C-Based Estimated GFR: Interpretation According to Performance Compared to Measured GFR. Kidney Medicine 2023 · PMID 37753251
- Beernink JM, et al. Developments in albuminuria testing: A key biomarker for detection, prognosis and surveillance of kidney and cardiovascular disease. Diabetes Obesity and Metabolism 2025 · PMID 40143452
- Yanai H, et al. Molecular Biological and Clinical Understanding of the Pathophysiology and Treatments of Hyperuricemia and Its Association with Metabolic Syndrome, Cardiovascular Diseases and Chronic Kidney Disease. International Journal of Molecular Sciences 2021 · PMID 34502127
The 9 markers — and why each one is here
The adrenal hormone behind the commonest findable cause of high blood pressure, measured by mass spectrometry
Potassium and sodium — the electrolyte pattern that makes an aldosterone result interpretable, plus kidney and liver
Filtration without the muscle-mass error. The half of the kidney question creatinine gets wrong in this population
Protein and blood in the urine — the earliest evidence that the pressure is causing damage
An overactive thyroid raises systolic pressure and is trivially cheap to exclude
Insulin resistance and hypertension travel together and are treated together
Tracks with blood pressure and changes which drug makes sense — losartan lowers urate and the rest of its class does not
Inflammatory contribution to vascular risk, and the decoder for the rest of the panel
What this panel is ordered to decide
A panel is a set of numbers until it settles something. These are the decisions this one feeds — each links the pathway it belongs to, what that pathway claims, and what its test list is read for.
ADMA inhibits nitric oxide synthase directly, so it is the most specific endothelial marker available. Dysfunction here precedes visible plaque by decades.
The rhythm is the diagnosis, not the level. Worth being blunt: 'adrenal fatigue' is not a recognized condition and the glands rarely fail — but a flattened cortisol curve is real, measurable and treatable.
Related panels
A panel gives you numbers. Skool is where they get read — 103 marker breakdowns with the optimal range rather than just the lab range, 42 evidence-graded protocols, and me answering questions daily. $10/mo, cancel anytime.
Join Skool — $10/mo →Frequently asked questions
9 markers: Aldosterone, Comprehensive Metabolic Panel (CMP), Cystatin C with eGFR, Urinalysis, Routine, TSH (Thyroid-Stimulating Hormone), HbA1c (Hemoglobin A1c), Lipid Panel, Uric Acid, hs-CRP (C-Reactive Protein, High Sensitivity).
$178.50 before discount, $160.65 with code CAMERON applied automatically. Individual markers add a one-time $10 draw fee. Ordered through Marek Diagnostics and drawn at any Quest Diagnostics location in the US.
No. These are ordered direct-to-consumer through Marek Diagnostics — you order online, walk into a Quest location, and results are emailed to you in about two weeks. No physician visit or insurance required. Not available in NY, NJ or RI.
Sit upright for at least 15 minutes before the draw and do not draw lying down — aldosterone is posture-dependent and a recumbent sample is not comparable to a seated one. Morning, between 8 and 10am. Fast 9-12 hours. Do not stop any blood pressure medication for this test without your prescriber: several of them move aldosterone and renin, and stopping them is a decision that belongs with whoever started them. Write down every drug you take on the requisition instead. Avoid licorice for two weeks; it mimics aldosterone excess convincingly.
A raised or high-normal aldosterone with a potassium at or below the bottom of the range is the combination that earns a renin measurement and a specialist conversation. A normal aldosterone with a normal potassium makes primary aldosteronism much less likely but does not exclude it, particularly on medication. A reduced cystatin C filtration rate or protein in the urine moves the priority to the kidney. A suppressed TSH points at the thyroid. Everything normal means the hypertension is the ordinary kind, and the work is blood pressure measurement at home, sodium, weight, alcohol and sleep.
Where this goes next
The pages here are the frameworks. The protocols — the dosing, the order to correct things in, the week-by-week schedule and what to retest — are inside Skool.