Abstract：
OBJECTIVE: The aim of this study is to evaluate performance of aldosterone-to-renin ratio (ARR) before washout of antihypertensive drugs as a screening test for primary aldosteronism (PA).
METHODS: This retrospective analysis included consecutive patients suspected of having secondary hypertension during a period from January 2017 to May 2022 at authors\' institute. For inclusion in the final analysis, ARR must be available prior to as well as after discontinuation of antihypertensives. Patients with ARR ≥2.4(ng/dL)/(μIU/mL) after washout proceeded to confirmatory tests. Diagnosis of PA was established based on positive result of the confirmatory test. Diagnostic accuracy of ARR prior to the washout in predicting PA are shown as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
RESULTS: The analysis included a total of 1306 patients [median age of 50.2 (41.0-59.0) years, 64.0% male]. Confirmatory tests showed PA in 215(16.5%) patients and essential hypertension (EH) in the remaining 1091(83.5%) patients. In comparison to the second screening test, the first screening test (before washout of antihypertensives) yielded lower plasma aldosterone and higher renin, and consequently lower ARR in both the PA and EH groups. At a cutoff of 0.7(ng/dL)/(μIU/ml), ARR before washout had 96.3% sensitivity, 61.2% specificity, 0.33 PPV and 0.99 NPV. At a lower cutoff of 0.5(ng/dL)/(μIU/ml), the sensitivity, specificity, PPV and NPV are 97.7%, 52.0%, 0.29 and 0.99.
CONCLUSIONS: ARR prior to washout of antihypertensives is a sensitive screening test for PA. Washout of antihypertensives could be omitted and further investigation for PA is not warranted if ARR was ≤ 0.7(ng/dL)/(μIU/ml) before washout.
METHODS: This retrospective analysis included consecutive patients suspected of having secondary hypertension during a period from January 2017 to May 2022 at authors\' institute. For inclusion in the final analysis, ARR must be available prior to as well as after discontinuation of antihypertensives. Patients with ARR ≥2.4(ng/dL)/(μIU/mL) after washout proceeded to confirmatory tests. Diagnosis of PA was established based on positive result of the confirmatory test. Diagnostic accuracy of ARR prior to the washout in predicting PA are shown as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
RESULTS: The analysis included a total of 1306 patients [median age of 50.2 (41.0-59.0) years, 64.0% male]. Confirmatory tests showed PA in 215(16.5%) patients and essential hypertension (EH) in the remaining 1091(83.5%) patients. In comparison to the second screening test, the first screening test (before washout of antihypertensives) yielded lower plasma aldosterone and higher renin, and consequently lower ARR in both the PA and EH groups. At a cutoff of 0.7(ng/dL)/(μIU/ml), ARR before washout had 96.3% sensitivity, 61.2% specificity, 0.33 PPV and 0.99 NPV. At a lower cutoff of 0.5(ng/dL)/(μIU/ml), the sensitivity, specificity, PPV and NPV are 97.7%, 52.0%, 0.29 and 0.99.
CONCLUSIONS: ARR prior to washout of antihypertensives is a sensitive screening test for PA. Washout of antihypertensives could be omitted and further investigation for PA is not warranted if ARR was ≤ 0.7(ng/dL)/(μIU/ml) before washout.
摘要：
目的：本研究的目的是评估抗高血压药物洗脱前醛固酮与肾素比值（ARR）作为原发性醛固酮增多症（PA）筛查试验的表现。
方法：这项回顾性分析包括作者研究所2017年1月至2022年5月期间怀疑患有继发性高血压的连续患者。为了纳入最终分析，ARR必须在抗高血压药停药之前和之后提供。清除后ARR≥2.4（ng/dL）/（μIU/mL）的患者进行验证性测试。根据确证试验的阳性结果确定PA的诊断。在预测PA时冲洗前ARR的诊断准确性显示为灵敏度，特异性，阳性预测值(PPV)和阴性预测值(NPV)。
结果：该分析共包括1306名患者[中位年龄50.2（41.0-59.0）岁，64.0%男性]。确证试验显示，PA在215例（16.5％）患者中，原发性高血压（EH）在其余1091例（83.5％）患者中。与第二次筛查测试相比，第一次筛查试验（在抗高血压药物洗脱之前）产生较低的血浆醛固酮和较高的肾素，从而降低PA和EH组的ARR。在0.7(ng/dL)/(μIU/ml)的截止值下，冲洗前的ARR灵敏度为96.3％，61.2%的特异性，0.33PPV和0.99NPV。在0.5(ng/dL)/(μIU/ml)的下限下，灵敏度,特异性，PPV和NPV为97.7%，52.0%,0.29和0.99。
结论：抗高血压药清除前的ARR是PA的敏感筛查试验。可以省略抗高血压药的冲洗，如果冲洗前ARR≤0.7（ng/dL）/（μIU/ml），则不需要对PA进行进一步研究。
方法：这项回顾性分析包括作者研究所2017年1月至2022年5月期间怀疑患有继发性高血压的连续患者。为了纳入最终分析，ARR必须在抗高血压药停药之前和之后提供。清除后ARR≥2.4（ng/dL）/（μIU/mL）的患者进行验证性测试。根据确证试验的阳性结果确定PA的诊断。在预测PA时冲洗前ARR的诊断准确性显示为灵敏度，特异性，阳性预测值(PPV)和阴性预测值(NPV)。
结果：该分析共包括1306名患者[中位年龄50.2（41.0-59.0）岁，64.0%男性]。确证试验显示，PA在215例（16.5％）患者中，原发性高血压（EH）在其余1091例（83.5％）患者中。与第二次筛查测试相比，第一次筛查试验（在抗高血压药物洗脱之前）产生较低的血浆醛固酮和较高的肾素，从而降低PA和EH组的ARR。在0.7(ng/dL)/(μIU/ml)的截止值下，冲洗前的ARR灵敏度为96.3％，61.2%的特异性，0.33PPV和0.99NPV。在0.5(ng/dL)/(μIU/ml)的下限下，灵敏度,特异性，PPV和NPV为97.7%，52.0%,0.29和0.99。
结论：抗高血压药清除前的ARR是PA的敏感筛查试验。可以省略抗高血压药的冲洗，如果冲洗前ARR≤0.7（ng/dL）/（μIU/ml），则不需要对PA进行进一步研究。
