Abstract：
UNASSIGNED: Aldosterone-to-renin ratio (ARR) based screening is the first step in the diagnosis of primary aldosteronism (PA). However, the guideline-recommended ARR cutoff covers a wide range, from the equivalent of 1.3 to 4.9 ng·dl-1/mIU∙l-1. We aimed to optimize the ARR cutoff for PA screening based on the risk of cardiovascular diseases (CVD).
UNASSIGNED: Longitudinally, we included hypertensive participants from the Framingham Offspring Study (FOS) who attended the sixth examination cycle and followed up until 2014. At baseline (1995-1998), we used circulating concentrations of aldosterone and renin to calculate ARR (unit: ng·dl-1/mIU∙l-1) among 1,433 subjects who were free of CVD. We used spline regression to calculate the ARR threshold based on the incident CVD. We used cross-sectional data from the Chongqing Primary Aldosteronism Study (CONPASS) to explore whether the ARR cutoff selected from FOS is applicable to PA screening.
UNASSIGNED: In FOS, CVD risk increased with an increasing ARR until a peak of ARR 1.0, followed by a plateau in CVD risk (hazard ratio 1.49, 95%CI 1.19-1.86). In CONPASS, when compared to essential hypertension with ARR < 1.0, PA with ARR ≥ 1.0 carried a higher CVD risk (odds ratio 2.24, 95%CI 1.41-3.55), while essential hypertension with ARR ≥ 1.0 had an unchanged CVD risk (1.02, 0.62-1.68). Setting ARR cutoff at 2.4 ~ 4.9, 10% ~30% of PA subjects would be unrecognized although they carried a 2.45 ~ 2.58-fold higher CVD risk than essential hypertension.
UNASSIGNED: The CVD risk-based optimal ARR cutoff is 1.0 ng·dl-1/mIU∙l-1 for PA screening. The current guideline-recommended ARR cutoff may miss patients with PA and high CVD risk.
UNASSIGNED: ClinicalTrials.gov (NCT03224312).
UNASSIGNED: Longitudinally, we included hypertensive participants from the Framingham Offspring Study (FOS) who attended the sixth examination cycle and followed up until 2014. At baseline (1995-1998), we used circulating concentrations of aldosterone and renin to calculate ARR (unit: ng·dl-1/mIU∙l-1) among 1,433 subjects who were free of CVD. We used spline regression to calculate the ARR threshold based on the incident CVD. We used cross-sectional data from the Chongqing Primary Aldosteronism Study (CONPASS) to explore whether the ARR cutoff selected from FOS is applicable to PA screening.
UNASSIGNED: In FOS, CVD risk increased with an increasing ARR until a peak of ARR 1.0, followed by a plateau in CVD risk (hazard ratio 1.49, 95%CI 1.19-1.86). In CONPASS, when compared to essential hypertension with ARR < 1.0, PA with ARR ≥ 1.0 carried a higher CVD risk (odds ratio 2.24, 95%CI 1.41-3.55), while essential hypertension with ARR ≥ 1.0 had an unchanged CVD risk (1.02, 0.62-1.68). Setting ARR cutoff at 2.4 ~ 4.9, 10% ~30% of PA subjects would be unrecognized although they carried a 2.45 ~ 2.58-fold higher CVD risk than essential hypertension.
UNASSIGNED: The CVD risk-based optimal ARR cutoff is 1.0 ng·dl-1/mIU∙l-1 for PA screening. The current guideline-recommended ARR cutoff may miss patients with PA and high CVD risk.
UNASSIGNED: ClinicalTrials.gov (NCT03224312).
摘要：
■基于醛固酮与肾素比率（ARR）的筛查是诊断原发性醛固酮增多症（PA）的第一步。然而,指南建议的ARR截止范围很广，从相当于1.3到4.9ng·dl-1/mIU·l-1。我们旨在根据心血管疾病（CVD）的风险优化PA筛查的ARR截止值。
■纵向，我们纳入了参加第六个检查周期并随访至2014年的Framingham后代研究(FOS)的高血压参与者.在基线(1995-1998年)，我们使用醛固酮和肾素的循环浓度计算了1,433名无CVD受试者的ARR(单位:ng·dl-1/mIU·l-1).我们使用样条回归来计算基于入射CVD的ARR阈值。我们使用重庆原发性醛固酮增多症研究（CONPASS）的横截面数据来探讨从FOS中选择的ARR截止值是否适用于PA筛查。
■在FOS中，CVD风险随着ARR的增加而增加，直至ARR1.0的峰值，随后是CVD风险的平稳期（风险比1.49，95CI1.19-1.86）。在CONPASS,与ARR<1.0的原发性高血压相比，ARR≥1.0的PA具有更高的CVD风险（比值比2.24，95CI1.41-3.55），而ARR≥1.0的原发性高血压的CVD风险不变(1.02,0.62~1.68).将ARR临界值设定为2.4〜4.9，尽管他们的CVD风险比原发性高血压高2.45〜2.58倍，但仍有10％〜30％的PA受试者未被识别。
■用于PA筛查的基于CVD风险的最佳ARR临界值为1.0ng·dl-1/mIU.l-1。当前指南推荐的ARR截止值可能会错过PA和高CVD风险患者。
■ClinicalTrials.gov（NCT03224312）。
■纵向，我们纳入了参加第六个检查周期并随访至2014年的Framingham后代研究(FOS)的高血压参与者.在基线(1995-1998年)，我们使用醛固酮和肾素的循环浓度计算了1,433名无CVD受试者的ARR(单位:ng·dl-1/mIU·l-1).我们使用样条回归来计算基于入射CVD的ARR阈值。我们使用重庆原发性醛固酮增多症研究（CONPASS）的横截面数据来探讨从FOS中选择的ARR截止值是否适用于PA筛查。
■在FOS中，CVD风险随着ARR的增加而增加，直至ARR1.0的峰值，随后是CVD风险的平稳期（风险比1.49，95CI1.19-1.86）。在CONPASS,与ARR<1.0的原发性高血压相比，ARR≥1.0的PA具有更高的CVD风险（比值比2.24，95CI1.41-3.55），而ARR≥1.0的原发性高血压的CVD风险不变(1.02,0.62~1.68).将ARR临界值设定为2.4〜4.9，尽管他们的CVD风险比原发性高血压高2.45〜2.58倍，但仍有10％〜30％的PA受试者未被识别。
■用于PA筛查的基于CVD风险的最佳ARR临界值为1.0ng·dl-1/mIU.l-1。当前指南推荐的ARR截止值可能会错过PA和高CVD风险患者。
■ClinicalTrials.gov（NCT03224312）。
