Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China.
Blood Press. 2024 May 3;33(1):2350981. doi: 10.1080/08037051.2024.2350981. Epub 2024 Jun 2.
Few studies have evaluated the performance of non-drug-adjusted primary aldosteronism (PA) screening. Therefore, we aimed to examine the consistency between PA screening results with and without drug adjustment and to explore the effectiveness of screening without drug adjustment.
This prospective study included 650 consecutive patients with a high risk of incidence PA. Patients who initially screened positive underwent rescreening with drug adjustments and confirmatory tests. Regarding the remaining patients, one of every three consecutive patients underwent rescreening with drug adjustments and confirmatory tests. The changes in aldosterone and renin concentrations were compared between patients with essential hypertension (EH) and those with PA before and after drug adjustment. Sensitivity and specificity were used to assess the diagnostic performance of screening without drug adjustment, using the confirmatory test results as the reference.
We screened 650 patients with hypertension for PA. Forty-nine patients were diagnosed with PA and 195 with EH. Regarding drugs, 519 patients were taking angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), or diuretics alone or in combination. Forty-one patients were taking beta-blockers. Ninety patients were taking beta-blockers in combination with other drugs. In patients treated with ACEIs, ARBs, CCBs, or diuretics alone, or in combination, or beta-blockers alone, PA positivity was determined using the criteria, aldosterone-to-renin ratio (ARR) >38 pg/mL/pg/mL and plasma aldosterone concentration (PAC) >100 pg/mL, and negativity, using the criteria, ARR <9 pg/mL/pg/mL; the sensitivity and specificity were 94.7% and 94.5%, respectively. After drug adjustment, the sensitivity and specificity of screening were 92.1% and 89%, respectively.
In patients not treated with beta-blockers combined with others, when ARR >38 pg/mL/pg/mL and plasma aldosterone concentration (PAC) >100 pg/mL, or, ARR <9 pg/mL/pg/mL, non-drug-adjusted screening results were identical to with drug adjustment. Non-drug-adjusted screening ould reduce the chance of medication adjustment, enable patients to continue their treatments and avoiding adverse effects, is of clinical importance.
很少有研究评估未经药物调整的原发性醛固酮增多症（PA）筛查的性能。因此，我们旨在检查伴有和不伴有药物调整的 PA 筛查结果之间的一致性，并探讨不进行药物调整的筛查的效果。
这项前瞻性研究纳入了 650 例高危原发性醛固酮增多症患者。最初筛查阳性的患者进行药物调整和确证试验的重新筛查。对于其余患者，每连续 3 例患者中的 1 例进行药物调整和确证试验的重新筛查。比较药物调整前后原发性高血压（EH）患者和 PA 患者的醛固酮和肾素浓度变化。使用确证试验结果作为参考，评估不进行药物调整的筛查的诊断性能，使用灵敏度和特异性进行评估。
我们对 650 例高血压患者进行了 PA 筛查。49 例被诊断为 PA，195 例被诊断为 EH。关于药物，519 例患者单独或联合服用血管紧张素转换酶抑制剂（ACEI）、血管紧张素Ⅱ受体阻滞剂（ARB）、钙通道阻滞剂（CCB）或利尿剂。41 例患者服用β受体阻滞剂。90 例患者服用β受体阻滞剂与其他药物联合使用。在单独或联合使用 ACEI、ARB、CCB 或利尿剂，或单独使用β受体阻滞剂的患者中，使用醛固酮/肾素比值（ARR）>38 pg/mL/pg/mL 和血浆醛固酮浓度（PAC）>100 pg/mL 来确定阳性，使用 ARR<9 pg/mL/pg/mL 来确定阴性，其灵敏度和特异性分别为 94.7%和 94.5%。药物调整后，筛查的灵敏度和特异性分别为 92.1%和 89%。
在未联合使用其他药物的β受体阻滞剂的患者中，当 ARR>38 pg/mL/pg/mL 和血浆醛固酮浓度（PAC）>100 pg/mL 或 ARR<9 pg/mL/pg/mL 时，未经药物调整的筛查结果与药物调整结果一致。未经药物调整的筛查可能会减少药物调整的机会，使患者能够继续接受治疗并避免不良反应，具有重要的临床意义。
