We enrolled 129 consecutive patients diagnosed with RH and no other causes of secondary hypertension. All patients underwent full biochemical assessment for PA, encompassing both basal measurements and a saline infusion test.
34/129 patients (26.4%) were diagnosed with PA. ARR alone provided a moderate-to-high accuracy in predicting the diagnosis of PA (AUC=0.908). Among normokalemic patients, the ARR value that maximized the diagnostic accuracy, as identified by the Youden index, was equal to 41.8 (ng/dL)/(ng/mL/h), and was characterized by a sensitivity and a specificity of 100% and 67%, respectively (AUC=0.882); an ARR > 179.6 (ng/dL)/(ng/mL/h) provided a 100% specificity for the diagnosis of PA, but was associated with a very low sensitivity of 20%. Among hypokalemic patients, the ARR value that maximized the diagnostic accuracy, as identified by the Youden index, was equal to 49.2 (ng/dL)/(ng/mL/h), and was characterized by a sensitivity and a specificity of 100% and 83%, respectively (AUC=0.941); an ARR > 104.0 (ng/dL)/(ng/mL/h) provided a 100% specificity for the diagnosis of PA, with a sensitivity of 64%.
Among normokalemic patients, there was a wide overlap in ARR values between those with PA and those with essential RH; the possibility to skip a confirmatory test should thus be considered with caution in this setting. A better discriminating ability could be seen in the presence of hypokalemia; in this case, ARR alone may be sufficient to skip confirmatory tests in a suitable percentage of patients.
■我们连续纳入129例诊断为RH且无其他原因的继发性高血压患者。所有患者都接受了PA的全面生化评估,包括基础测量和生理盐水输注测试。
■34/129例患者(26.4%)被诊断为PA。单独的ARR在预测PA的诊断中提供了中等到高的准确性(AUC=0.908)。在正常血钾症患者中,最大限度地提高诊断准确性的ARR值,正如尤登指数所确定的那样,等于41.8(ng/dL)/(ng/mL/h),以100%和67%的灵敏度和特异性为特征,分别(AUC=0.882);ARR>179.6(ng/dL)/(ng/mL/h)为诊断PA提供了100%的特异性,但与20%的非常低的灵敏度相关。在低钾血症患者中,最大限度地提高诊断准确性的ARR值,正如尤登指数所确定的那样,等于49.2(ng/dL)/(ng/mL/h),以100%和83%的灵敏度和特异性为特征,分别(AUC=0.941);ARR>104.0(ng/dL)/(ng/mL/h)为诊断PA提供了100%的特异性,灵敏度为64%。
■在正常白血病患者中,PA患者和原发性RH患者的ARR值存在广泛重叠;因此,在这种情况下,应谨慎考虑跳过验证性试验的可能性.在低钾血症的存在下,可以看到更好的辨别能力;在这种情况下,单独的ARR可能足以在适当比例的患者中跳过确认测试。