Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Medicine, Monash University, Clayton, VIC, Australia.
Endocrine. 2024 Jan;83(1):178-187. doi: 10.1007/s12020-023-03520-6. Epub 2023 Oct 5.
To determine whether antihypertensives will affect diagnostic accuracy of the aldosterone-to-renin ratio (ARR) to an extent that is clinically relevant.
Confirmatory tests were used to confirm or exclude PA diagnosis. Area under the receiver operating characteristic curve (AUC), specificity and sensitivity of ARR performance in different conditions were calculated.
208 PA and 78 essential hypertension (EH), and 125 PA and 206 EH patients, were included in the retrospective and prospective cohort, respectively. AUC of ARR on interfering medications was comparable to ARR off interfering medications (retrospective: 0.82 vs. 0.87, p = 0.20; prospective: 0.78 vs. 0.84, p = 0.07). At a threshold of 20 pg/μIU, the sensitivity of ARR on interfering medications was lower (11.1-23.2%) while the specificity was higher (10.2-15.2%) than ARR off interfering medications. However, when the ARR threshold on interfering medications was lowered to 10 pg/μIU, both the sensitivity (retrospective: 0.91 vs. 0.90, p = 0.61; prospective: 0.86 vs. 0.82, p = 0.39) and specificity (retrospective: 0.49 vs. 0.59, p = 0.20; prospective: 0.58 vs. 0.66, p = 0.10) were comparable to the ARR threshold off interfering medications.
Using ARR to screen for PA whilst taking interfering antihypertensive drugs is feasible in most cases, but the ARR threshold needs to be reduced.
ClinicalTrials.gov identifier: NCT04991961.
确定降压药是否会在临床上显著影响醛固酮与肾素比值（ARR）的诊断准确性。
采用确证性检验来确诊或排除原醛的诊断。计算不同条件下 ARR 性能的受试者工作特征曲线下面积（AUC）、特异性和敏感性。
回顾性和前瞻性队列分别纳入 208 例原醛和 78 例特发性高血压（EH）患者，以及 125 例原醛和 206 例 EH 患者。在干扰药物中 ARR 的 AUC 与未服用干扰药物时的 ARR 相当（回顾性：0.82 与 0.87，p=0.20；前瞻性：0.78 与 0.84，p=0.07）。在 20pg/μIU 的截断值时，ARR 在服用干扰药物时的敏感性较低（11.1%-23.2%），而特异性较高（10.2%-15.2%）。然而，当服用干扰药物时的 ARR 截断值降低至 10pg/μIU 时，ARR 的敏感性（回顾性：0.91 与 0.90，p=0.61；前瞻性：0.86 与 0.82，p=0.39）和特异性（回顾性：0.49 与 0.59，p=0.20；前瞻性：0.58 与 0.66，p=0.10）与未服用干扰药物时的 ARR 截断值相当。
在服用干扰降压药物的情况下，使用 ARR 筛查原醛是可行的，但 ARR 截断值需要降低。
ClinicalTrials.gov 标识符：NCT04991961。
