Abstract
Primary aldosteronism is a main cause of secondary hypertension which can be effectively treated. The screening test for primary aldosteronism is benefit for minimizing damage to the patient. In the previous retrospective study, we obtained the optimal cutoff value of aldosterone-to-renin ratio detected by chemiluminescence assay, a newly developing method, and prompted its high efficiency in primary aldosteronism screening in upright position. In this study, we want to evaluate its efficiency in practical work. We used this ratio to continuously screen 238 patients, and 58 patients were finally diagnosed with primary aldosteronism. We found it had 86.13% accuracy rate in the upright position compared with the final clinical diagnosis. False negative and positive rates were 13.79% and 13.89%. Diagnostic sensitivity and specificity were 86.21% and 86.11%, which are slightly different from results in our previous study. False negative rate can be improved by combining the aldosterone-to-renin ratio with aldosterone concentration. We also found impaired glucose tolerance may be a reason for high false positive rate. Besides, chemiluminescence assay may be interfered in aldosterone detection. Although it has some shortcomings, chemiluminescence assay-detected aldosterone-to-renin ratio is a highly effective index for screening primary aldosteronism in practice.
Highlights
Primary aldosteronism (PA), which accounts for 5% to 20% morbidity in resistant hypertension in different reports [1,2,3], is a main cause of secondary hypertension [4]
PA diagnosis was required to satisfy following conditions: (1) typical clinical features, like hypertension and hypokalemia; (2) adrenal hyperplasia or adenoma in imaging; (3) histopathology; and (4) approval test confirmation. e case included in the following study should at least have a complete ADRR in the upright position and a clear PA or non-PA diagnosis
In our previous retrospective study, we found the most effective cutoff value of chemiluminescence assay (CLIA)-detected ADRR in the upright position was 28 for PA screening, but we did not know its efficacy in actual work
Summary
Primary aldosteronism (PA), which accounts for 5% to 20% morbidity in resistant hypertension in different reports [1,2,3], is a main cause of secondary hypertension [4] It is caused by excess aldosterone secretion from one or both of adrenal glands. Chemiluminescence assay (CLIA) is applied for aldosterone and renin detection, which is a higher safety profile than the previously used radioimmunoassay (RIA) [7, 8] It is recommended in aldosterone and renin detection, CLIA is not extensively used in PA diagnosis, because of the controversies in the cutoff value and diagnostic efficiency of International Journal of Hypertension
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