Screening for primary aldosteronism in an argentinian population: a multicenter prospective study

Area of Science:

• Endocrinology
• Clinical Diagnostics
• Hypertension Research

Background:

• Primary aldosteronism (PA) is a condition of autonomous aldosterone overproduction.
• The aldosterone (ALD)/plasma renin activity (ARR) ratio is a key screening tool, with increasing prevalence.
• Establishing reliable diagnostic cut-off values is crucial for accurate PA screening.

Purpose of the Study:

• To determine cut-off values (COV) for ARR and ALD/plasma renin concentration (ARC) ratios in an Argentinian population.
• To assess the diagnostic concordance (DC%) between ARR and ARC in PA screening.
• To evaluate the utility of these ratios for identifying PA in hypertensive patients.

Main Methods:

• A multicenter prospective study involving 353 subjects (104 controls, 249 hypertensive patients).
• Serum aldosterone, PRA, and ARR were measured. Plasma renin concentration (PRC) was measured in a subset for ARC determination.
• COVs were derived from the 95th percentile of control subjects.

Main Results:

• Established COVs: ARR of 36 and ARC of 2.39 (with ALD ≥ 15 ng/dL).
• ARR ≥ 36 identified PA in a higher percentage of hypertensive patients compared to previous reports.
• Diagnostic concordance between ARR and ARC was 79.1%, with significant correlation observed at higher renin levels.

Conclusions:

• This study provides the first Argentinian multicenter-derived COVs for ARR (36) and ARC (2.39).
• Applying ARR ≥ 36 increased PA confirmation rates in hypertensive patients.
• Further research is needed to establish the clinical utility of ARC due to its limited concordance at lower renin levels.