Kao Ting-Wei, Chen Jui-Yi, Liu Jung-Hua, Tseng Wen-Hsin, Hsieh Chih-Chia, Wu Vin-Cent, Lin Yen-Hung, Chen Zheng-Wei
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Ther Adv Endocrinol Metab. 2024 Dec 11;15:20420188241303429. doi: 10.1177/20420188241303429. eCollection 2024.
The aldosterone-to-renin ratio (ARR) is commonly used for screening primary aldosteronism (PA) in patients with difficult-to-control hypertension. Various thresholds have been proposed for the confirmatory tests, leading to inconsistency in the results.
This study aimed to elucidate the performance of ARR screening in hypertensive patients.
Systemic review and meta-analysis.
PubMed, Embase, and the Cochrane Library were systematically searched from inception to January 2024. Studies that used the ARR to screen for PA and provided a comprehensive probability panel specifically focusing on hypertensive individuals were considered for enrollment. Pooled diagnostic efficacy was evaluated, and subgroup analyses and meta-regression were conducted based on different demographic and clinical parameters.
Eighteen observational studies encompassing 7150 participants were included in the meta-analysis. The overall prevalence of PA in the hypertensive cohort was 15.2%, and pooled sensitivity and specificity were 81.6% and 93.3%, respectively, resulting in a diagnostic odds ratio of 62.0. Fagan's nomogram showed that a positive ARR increased the post-test probability to 80% from a pre-test probability of 25%. Summary receiver operating characteristic curve analysis revealed an area under the curve of 94.7%. Notably, analysis of variability demonstrated that the diagnostic performance was consistent across either ARR based on plasma renin activity or direct renin concentration, geographic region, sex, mean age, potassium level, and systolic blood pressure.
ARR was validated as a viable screening methodology for PA in hypertensive individuals. Moreover, its diagnostic efficacy remained unchanged across diverse clinical contexts. Future studies are warranted to refine ARR methodologies and enhance diagnostic accuracy.
PROSPERO ID number CRD42023493680.
ARR, aldosterone-to-renin ratio; BP, blood pressure; DRC, direct renin concentration; hsROC, hierarchical summary receiver operating characteristic; PA, primary aldosteronism; PRA, plasma renin activity.
醛固酮与肾素比值（ARR）常用于筛查难以控制的高血压患者的原发性醛固酮增多症（PA）。已提出各种用于确诊试验的阈值，导致结果不一致。
本研究旨在阐明ARR筛查在高血压患者中的表现。
系统评价和荟萃分析。
从创刊至2024年1月，系统检索了PubMed、Embase和Cochrane图书馆。纳入使用ARR筛查PA并提供专门针对高血压个体的综合概率面板的研究。评估汇总诊断效能，并根据不同的人口统计学和临床参数进行亚组分析和荟萃回归。
荟萃分析纳入了18项观察性研究，共7150名参与者。高血压队列中PA的总体患病率为15.2%，汇总敏感性和特异性分别为81.6%和93.3%，诊断比值比为62.0。费根氏诺模图显示，阳性ARR将验后概率从验前概率的25%提高到80%。汇总的受试者工作特征曲线分析显示曲线下面积为94.7%。值得注意的是，变异性分析表明，基于血浆肾素活性或直接肾素浓度的ARR、地理区域、性别、平均年龄、血钾水平和收缩压方面，诊断性能是一致的。
ARR被验证为高血压个体PA的可行筛查方法。此外，其诊断效能在不同临床背景下保持不变。未来的研究有必要完善ARR方法并提高诊断准确性。
PROSPERO注册号CRD42023493680。
ARR，醛固酮与肾素比值；BP，血压；DRC，直接肾素浓度；hsROC，分层汇总受试者工作特征；PA，原发性醛固酮增多症；PRA，血浆肾素活性
