Abstract
Objectives: To validate the equilibrium angiotensin II (eqAngII) assay and to compare performance of the aldosterone/eqAngII ratio (AA2R) with the aldosterone/renin ratio (ARR) in screening for primary aldosteronism (PA). Methods: PA was excluded in 20 and confirmed in 48 patients by fludrocortisone suppression testing (FST). Blood was collected at 7 AM (recumbent) and 10 AM (upright) basally (day 0) and on day 4 of FST. Before measuring eqAngII and aldosterone (PAC) by LC-MS/MS, pre-stored frozen serum was subjected to ex vivo equilibration (1 h incubation at 37 °C) which is driven by intrinsic angiotensin interactions, followed by adding enzyme inhibitors to block further reactions. Direct renin concentration (DRC) was measured by CLIA. Results: Basally, PA patients showed higher (p 0.05), with predicted ARR cut-off at 52.4 pmol/mU (sensitivity 95.8%, specificity 85.0%) and AA2R at 8.5 pmol/pmol (93.8%, 80.0%). Conclusion: Dynamic changes of DRC and eqAngII show good consistency during FST, but eqAngII performs better than DRC at low concentrations. The AA2R performs at least as well as ARR and may have the potential for future application in PA screening.
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