From the Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia (Z.G., D.C., M.W., M.S.).
Attoquant Diagnostics GmbH, Vienna, Austria (M.P., O.D.).
Hypertension. 2020 Aug;76(2):488-496. doi: 10.1161/HYPERTENSIONAHA.120.14871. Epub 2020 Jun 8.
The aldosterone/renin ratio (ARR) is currently considered the most reliable approach for case detection of primary aldosteronism (PA). ACE (Angiotensin-converting enzyme) inhibitors are known to raise renin and lower aldosterone levels, thereby causing false-negative ARR results. Because ACE inhibitors lower angiotensin II levels, we hypothesized that the aldosterone/equilibrium angiotensin II (eqAngII) ratio (AA2R) would remain elevated in PA. Receiver operating characteristic curve analysis involving 60 patients with PA and 40 patients without PA revealed that the AA2R was not inferior to the ARR in screening for PA. When using liquid chromatography-tandem mass spectrometry to measure plasma aldosterone concentration, the predicted optimal AA2R cutoff for PA screening was 8.3 (pmol/L)/(pmol/L). We then compared the diagnostic performance of the AA2R with the ARR among 25 patients with PA administered ramipril (5 mg/day) for 2 weeks. Compared with basally, plasma levels of equilibrium angiotensin I (eqAngI) and direct renin concentration increased significantly (<0.01 or <0.05) after ramipril treatment, whereas eqAngII and ACE activity (eqAngII/eqAngI) decreased significantly (<0.01). The changes of plasma renin activity and plasma aldosterone concentration in the current study were not significant. On day 14, 4 patients displayed false-negative results using ARR_direct renin concentration (plasma aldosterone concentration/direct renin concentration), 3 of whom also showed false-negative ARR_plasma renin activity (plasma aldosterone concentration/plasma renin activity). On day 15, 2 patients still demonstrated false-negative ARR_plasma renin activity, one of whom also showed a false-negative ARR_direct renin concentration. No false-negative AA2R results were observed on either day 14 or 15. In conclusion, compared with ARR which can be affected by ACE inhibitors causing false-negative screening results, the AA2R seems to be superior in detecting PA among subjects receiving ACE inhibitors.
醛固酮/肾素比值（ARR）目前被认为是原发性醛固酮增多症（PA）病例检测最可靠的方法。血管紧张素转换酶（ACE）抑制剂已知会升高肾素并降低醛固酮水平，从而导致 ARR 结果出现假阴性。由于 ACE 抑制剂降低血管紧张素 II 水平，我们假设醛固酮/平衡血管紧张素 II（eqAngII）比值（AA2R）在 PA 中仍会升高。涉及 60 例 PA 患者和 40 例无 PA 患者的受试者工作特征曲线分析表明，AA2R 在筛查 PA 方面并不逊于 ARR。当使用液相色谱-串联质谱法测量血浆醛固酮浓度时，用于 PA 筛查的预测最佳 AA2R 截止值为 8.3（pmol/L）/（pmol/L）。然后，我们比较了在 25 例接受雷米普利（5mg/天）治疗 2 周的 PA 患者中 AA2R 与 ARR 的诊断性能。与基础值相比，雷米普利治疗后平衡血管紧张素 I（eqAngI）和直接肾素浓度显著升高（<0.01 或 <0.05），而 eqAngII 和 ACE 活性（eqAngII/eqAngI）显著降低（<0.01）。本研究中血浆肾素活性和血浆醛固酮浓度的变化不显著。第 14 天，ARR_直接肾素浓度（血浆醛固酮浓度/直接肾素浓度）的 4 例患者显示假阴性结果，其中 3 例也显示 ARR_血浆肾素活性（血浆醛固酮浓度/血浆肾素活性）的假阴性结果。第 15 天，2 例患者仍显示 ARR_血浆肾素活性的假阴性结果，其中 1 例也显示 ARR_直接肾素浓度的假阴性结果。在第 14 天或第 15 天均未观察到 AA2R 的假阴性结果。总之，与可能因 ACE 抑制剂导致假阴性筛查结果的 ARR 相比，AA2R 在接受 ACE 抑制剂治疗的患者中检测 PA 似乎更具优势。
