da Silveira João Vicente, Sangaleti Carine, Camacho Cleber, Maciel Ana Alice Wolf, Irigoyen Maria Claudia, Macedo Thiago, De Lima José Jayme G, Drager Luciano F, Bortolotto Luiz Aparecido, Lopes Heno Ferreira, Almeida Madson Q, Egan Brent M, Consolim-Colombo Fernanda Marciano
Medical School, Universidade Nove de Julho-Uninove, São Paulo 04101-200, Brazil.
Cardiology Department, Unidade de Hipertensão, Instituto do Coração-Universidade de São Paulo-HC-FMUSP, São Paulo 05403-000, Brazil.
J Cardiovasc Dev Dis. 2024 Sep 27;11(10):299. doi: 10.3390/jcdd11100299.
Primary aldosteronism (PA) is commonly associated with resistant hypertension. Biochemical tests can be clinically useful in the screening and diagnosis of primary aldosteronism. This study aimed to identify the cutoff values of aldosterone levels (A) and the aldosterone-renin ratio (ARR) for an accurate prediction of PA in patients with apparent resistant hypertension in a real-life scenario. This database-based study included a historical cohort of male and female patients with apparent resistant hypertension, aged 18 years or older and surveyed for PA in a specialized center from 2008 to 2018. Aldosterone and plasma renin activity (PRA) or the plasma renin concentration (PRC) were measured in the treated hypertensive patients. The patients with positive screening results were subsequently referred to the endocrinology department for confirmatory tests. The patients with confirmed PA were included in the case group, and the others remained as controls. Receiver-operating characteristic (ROC) curves were used to identify the cutoff points for aldosterone and the ARR, thereby analyzing their sensitivity and specificity for confirmed PA. Among the 3464 patients (59 ± 13 years old, 41% male) who had apparent resistance hypertension screened, PA was confirmed in 276 individuals (8%). A ≥ 16.95 ng/dL (95% CI: 0.908-0.933) had an odds ratio of 6.24 for PA, while A/PRA ≥ 29.88 (95% CI: 0.942-0.984) or an A/PRC ≥ 2.44 (95% CI: 0.978-0.990) had an odds ratio of 216.17 for PA diagnoses. Our findings suggest that a positive PA screening with aldosterone ≥ 17 ng/dL associated with A/PRA ≥ 29.88 or an A/PRC ratio of ≥2.44 should be sufficient to confirm the diagnosis of PA without confirmatory testing.
原发性醛固酮增多症（PA）通常与顽固性高血压相关。生化检测在原发性醛固酮增多症的筛查和诊断中具有临床应用价值。本研究旨在确定在现实生活场景中，对于明显顽固性高血压患者准确预测PA的醛固酮水平（A）和醛固酮-肾素比值（ARR）的临界值。这项基于数据库的研究纳入了一个历史队列，该队列中的男性和女性患者年龄在18岁及以上，患有明显的顽固性高血压，并于2008年至2018年在一个专科中心接受PA筛查。在接受治疗的高血压患者中测量醛固酮和血浆肾素活性（PRA）或血浆肾素浓度（PRC）。筛查结果呈阳性的患者随后被转诊至内分泌科进行确诊检查。确诊为PA的患者被纳入病例组，其余患者作为对照组。采用受试者操作特征（ROC）曲线来确定醛固酮和ARR的临界点，从而分析它们对确诊PA的敏感性和特异性。在3464例接受明显顽固性高血压筛查的患者（59±13岁，41%为男性）中，276例（8%）确诊为PA。A≥16.95 ng/dL（95% CI：0.908 - 0.933）时PA的优势比为6.24，而A/PRA≥29.88（95% CI：0.942 - 0.984）或A/PRC≥2.44（95% CI：0.978 - 0.990）时PA诊断的优势比为216.17。我们的研究结果表明，醛固酮≥17 ng/dL且A/PRA≥29.88或A/PRC比值≥2.44的PA筛查阳性结果应足以确诊PA，无需进行确诊检查。
