Performance of Aldosterone-to-renin Ratio Before Washout of Antihypertensive Drugs in Screening of Primary Aldosteronism
Authors' conclusion
ARR prior to washout of antihypertensives is a sensitive screening test for PA. Washout of antihypertensives could be omitted and further investigation for PA is not warranted if ARR is ≤ .7(ng/dL)/(μIU/mL) before washout.
Study context
- Population
- Consecutive patients screened for secondary hypertension, January 2017 to May 2022, with aldosterone-to-renin ratio (ARR) available before and after discontinuation of antihypertensives; median age 50.2 (41.0–59.0) years, 64.0% male
- Participants
- 1,306 patients
- Comparison
- ARR before washout of antihypertensives vs confirmatory test diagnosis of primary aldosteronism (PA)
- Outcome
- Diagnostic accuracy (sensitivity, specificity, PPV, NPV) of ARR before washout in predicting PA, diagnosed by positive confirmatory test
Methodological detailsretrospective, consecutive patients
- Retrospective
- Consecutive patients
Performance
As reported in the abstract
Diagnostic accuracy of ARR before washout for PA
| Strategy | Sensitivity | Specificity | PPV | NPV |
|---|---|---|---|---|
| ARR cutoff .7 | 96.3% | 61.2% | .33 | .99 |
| ARR cutoff .5 | 97.7% | 52.0% | .29 | .99 |
Sensitivity
ARR cutoff .796.3%
ARR cutoff .597.7%
Specificity
ARR cutoff .761.2%
ARR cutoff .552.0%
PPV
ARR cutoff .7.33
ARR cutoff .5.29
NPV
ARR cutoff .7.99
ARR cutoff .5.99
Further findings
Diagnosis by confirmatory tests
- PA
- 215(16.5%)
- Essential hypertension (EH)
- 1091(83.5%)
First vs second screening test
- Before washout: lower plasma aldosterone, higher renin and lower ARR in both PA and EH
Original publication
Performance of Aldosterone-to-renin Ratio Before Washout of Antihypertensive Drugs in Screening of Primary Aldosteronism. J Clin Endocrinol Metab. Published 21 February 2024. doi:10.
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