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Screening for primary aldosteronism on and off interfering medications

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Abstract

Objective

To determine whether antihypertensives will affect diagnostic accuracy of the aldosterone-to-renin ratio (ARR) to an extent that is clinically relevant.

Methods

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.

Results

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.

Conclusion

Using ARR to screen for PA whilst taking interfering antihypertensive drugs is feasible in most cases, but the ARR threshold needs to be reduced.

Trial registration

ClinicalTrials.gov identifier: NCT04991961.

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Acknowledgements

The authors thank the other members of the CONPASS (Chongqing Primary Aldosteronism Study) Group: Mei Mei, MD, PhD, Suxin Luo, MD, PhD, Kangla Liao, MD, Yao Zhang, MD, PhD, Yunfeng He, MD, PhD, Yihong He, MD, Ming Xiao, PhD, and Bin Peng, PhD, for suggestions on study design and revision.

On behalf of the Chongqing Primary Aldosteronism Study (CONPASS) Group

Mei Mei1, Suxin Luo6, Kangla Liao6, Yao Zhang7, Yunfeng He7, Yihong He8, Ming Xiao9, Bin Peng10

Funding

This work is supported by the National Natural Science Foundation of China (82100833, U21A20355); Joint Medical Research Project of Chongqing Science and Technology Commission & Chongqing Health and Family Planning Commission (Major Project, 2022ZDXM003); National Key Research & Development Plan of China, major project of prevention and treatment for common diseases (2021YFC2501600, sub-project: 2021YFC2501603). The National Key Research and Development Project (2022YFC2505300, sub-project 2022YFC2505301)

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Author notes

  1. These authors contributed equally: Xiaoyu Li, Jiayu Liang

Authors and Affiliations

  1. Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Xiaoyu Li, Jiayu Liang, Jinbo Hu, Linqiang Ma, Ying Jing, Ying Song, Yi Yang, Zhengping Feng, Zhipeng Du, Yue Wang, Ting Luo, Wenwen He, Shumin Yang, Qifu Li & Mei Mei

  2. Department of Medicine, Monash University, Clayton, VIC, Australia

    Jun Yang

  3. Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia

    Jun Yang

  4. Graduate Administration Office, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Aipin Zhang

  5. Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China

    Xiaoyu Shu

  6. Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Suxin Luo & Kangla Liao

  7. Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Yao Zhang & Yunfeng He

  8. Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Yihong He

  9. Department of Pathology, Chongqing Medical University, Chongqing, China

    Ming Xiao

  10. School of Public Health and Management, Chongqing Medical University, Chongqing, China

    Bin Peng

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  1. Xiaoyu Li
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Consortia

on behalf of the Chongqing Primary Aldosteronism Study (CONPASS) Group

  • Mei Mei
  • , Suxin Luo
  • , Kangla Liao
  • , Yao Zhang
  • , Yunfeng He
  • , Yihong He
  • , Ming Xiao
  •  & Bin Peng

Contributions

S.Y., Q.L., and S.X. contributed to study conception and design. L.X. and L.J. conducted the data analysis and wrote the manuscript. H.J., M.L., J.Y., Z.A., J.Y., S.Y., and Y.Y. collected the data. F.Z., D.Z., W.Y., and L.T., H.W. contributed to the critical revision of the article. All authors had access to the study data, were involved in the analysis and interpretation of the data, take responsibility for the accuracy of the analysis, and had authority over manuscript preparation and the decision to submit the manuscript for publication. All authors approve the manuscript for submission.

Corresponding authors

Correspondence to Xiaoyu Shu, Shumin Yang or Qifu Li.

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Li, X., Liang, J., Hu, J. et al. Screening for primary aldosteronism on and off interfering medications. Endocrine 83, 178–187 (2024). https://doi.org/10.1007/s12020-023-03520-6

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