ABSTRACT
Primary aldosteronism(PA) is one of the most common causes of secondary hypertension,plasma aldosterone concentration(PAC)/plasma renin activity (PRA) ratio is widely used in clinical practice.However,PRA reflects the level of plasma renin indirectly.In recent years,plasma renin concentration (PRC) has been measured by automatic chemiluminescence immunoassay,which is more stable,convenient and with less confounding factors than conventional renin activity.This review briefly introduces methods of examining PRA,PRC and PAC,and compares the value of PAC/PRC ratio with PAC/PRA ratio in PA detection.
ABSTRACT
Objective To explore the best way for clinical screening of primary aldosteronism (PA).Methods Three hundred and three suspected cases of PA were collected and divided into groups of primary aldosteronism group, essential hypertension group, and nonsecreting cortical adrenal tumor group.The plasma aldosterone concentration/plasma renin concentration ratio ( ARR) was used to draw the receiver operating characteristic ( ROC) curve and obtain the best cut-off point.Furthermore, the current screening schemes for PA were compared.Results Upright ARR yield had larger areas under the ROC curve than plasma aldosterone concentration or plasma renin concentration under all conditions of testing. The best cut-off point of upright ARR[(pg/ml)/(μIU/ml)] for the diagnosis of PA was 43.45.During the two postural stimulation tests,the two upright ARR exceeded 43.45 with the highest diagnostic sensitivity of PA reaching 0.94.During the two upright tests ARR was less than 43.45, with a sensitivity of 0.74, and a specificity of 0.94.Conclusion To screen for PA in high-risk populations, twice postural stimulation test is recommended.As long as the upright ARR is above 43.45, PA may be considered and further confirmation is needed to prevent misdiagnosis.