Diagnostic Accuracy of the Aldosterone-to-Active Renin Ratio for Detecting Primary Aldosteronism.

Abstract

CONTEXT:

The aldosterone-to-active renin ratio (AARR) is the recommended screening test for primary aldosteronism (PA), but prospective study data on its sensitivity and specificity are sparse.

OBJECTIVE:

To investigate the diagnostic accuracy of the AARR for detecting PA.

DESIGN:

Prospective diagnostic accuracy study.

SETTING:

This study was conducted from February 2009 to August 2015 at the outpatient clinic of the Department of Endocrinology and Diabetology of the Medical University of Graz, Austria.

PARTICIPANTS:

Four hundred patients with arterial hypertension who were referred to a tertiary care center for screening for endocrine hypertension.

INTERVENTION:

Participants had a determination of the AARR (index test) and a second AARR determination followed by a saline infusion test (SIT) after 2 to 6 weeks. PA was diagnosed in individuals with any AARR ≥3.7 ng/dL/µU/mL [including a plasma aldosterone concentration (PAC) of ≥9 ng/dL] who had a PAC ≥10 ng/dL after the SIT. We did not substantially alter antihypertensive drug intake.

MAIN OUTCOME MEASURES:

Primary outcome was the receiver-operating characteristic (ROC) curve of the AARR in diagnosing PA.

RESULTS:

A total of 382 participants were eligible for analyses; PA was diagnosed in 18 (4.7%) patients. The area under the ROC curve of the AARR in detecting PA was 0.973 (95% CI, 0.956 to 0.990). Sensitivity and specificity for a positive AARR in diagnosing PA were 100% (95% CI, 81.5% to 100.0%) and 89.6% (95% CI, 86.0% to 92.5%), respectively.

CONCLUSIONS:

The AARR has good diagnostic accuracy for detecting PA.

• Authors: Stefan Pilz, Martin H Keppel, Christian Trummer, Verena Theiler-Schwetz, Marlene Pandis, Valentin Borzan, Matthias Pittrof, Barbara Obermayer-Pietsch, Martin R Grübler, Nicolas Verheyen, Vinzenz Stepan, Andreas Meinitzer, Jakob Voelkl, Winfried März, Andreas Tomaschitz
• Journal: Journal of the Endocrine Society (J Endocr Soc) Vol. 3 Issue 9 Pg. 1748-1758 (Sep 01 2019) ISSN: 2472-1972 [Electronic] United States
• PMID: 31528833 (Publication Type: Journal Article)