Aldosterone-to-renin ratio for diagnosing aldosterone-producing adenoma: A multicentre study

Abstract

The proposed cut-off value of 32 ng/ng for ARR (minimum renin value set at 5 ng/L) in one of two determinations had 100% sensitivity and 72% specificity with 20% positive and 100% negative predictive values for diagnosing APA.

PROGRESS IN ALDOSTERONISM: A review of the prevalence of primary aldosteronism in pre-hypertension and hypertension

“…In the remaining three patients, the diagnosis of PA was not confirmed either due to an unaccounted ACTH surge or due to a false-positive ARR increasing the population requiring unnecessary confirmatory testing to ascertain the diagnosis. The sensitivity and specificity of basal ARR were found to be 18 and 98% respectively, considerably different from those published so far (16,70,87). These findings suggest that the use of basal ARR alone permits the detection of more advanced cases of PA leaving milder forms undiagnosed.…”

Reliability of a Bayesian network to predict an elevated aldosterone-to-renin ratio

“…However, the criteria used to select patients met current recommendations and the main characteristics of our study population were similar to those usually reported in the literature [9]. In our study, the true disease status was based on an ARR > 32 ng/L after ≥ 1 hour in the reclined position or after 1 hour supine (with a plasma aldosterone value > 160 ng/L) [17]. The ARR based on the measurement of active renin is a valuable alternative to plasma renin activity [20].…”

“…We recorded factors that are clearly linked to the risk of primary aldosteronism [10,17] and discarded those that are still debated in the literature. Accordingly, the following data were collected:…”

“…Aldosterone and renin concentrations (both expressed in ng/L) were determined after 1 hour in the supine position and after ≥ 1 hour in the standing position. An ARR > 32 ng/L with a plasma aldosterone value > 160 ng/L was used to define elevated ARR [17].…”

Measurement of plasma renin concentration instead of plasma renin activity decreases the positive aldosterone-to-renin ratio tests in treated patients with essential hypertension

“…Since the introduction of direct renin assays in the clinical arena, several studies have examined ARR calculated with PRC [22][23][24][25][26][27][28] in patients with essential hypertension, but only in three of these comparing ARRD and ARRP [22,24,25]. However, all these investigations were carried out while patients were off treatment with antihypertensive agents, whereas we elected, on purpose, to perform our study while the majority of our patients were on their usual antihypertensive medications to assess how these drugs affect the specificity of ARRP and ARRD.…”