Poor Performance of Angiotensin II Enzyme-Linked Immuno-Sorbent Assays in Mostly Hypertensive Cohort Routinely...

Area of Science:

• Endocrinology
• Hypertension Research
• Biochemical Diagnostics

Background:

• Primary aldosteronism (PA) is the most common cause of secondary hypertension, yet it is frequently underdiagnosed.
• Current biochemical screening for PA involves assessing angiotensin II (Ang II) and calculating the aldosterone-to-angiotensin II ratio (AA2R).

Purpose of the Study:

• To evaluate the diagnostic performance of the AA2R as a screening test for PA.
• To compare the effectiveness of AA2R with the routinely used aldosterone-to-direct renin ratio (ADRR).

Main Methods:

• Utilized enzyme-linked immunosorbent assay (ELISA) for Ang II measurement, a novel application for PA screening.
• Compared biochemical markers in a cohort of 20 PA patients and 80 controls.
• Calculated and analyzed the diagnostic performance metrics (AUROC, sensitivity, specificity) for AA2R and ADRR.

Main Results:

• Angiotensin II concentrations did not differ significantly between PA and non-PA groups.
• The AA2R was significantly higher in the PA group compared to the non-PA group.
• The AA2R demonstrated significantly poorer diagnostic performance (AUROC 0.754) than the ADRR (AUROC 0.939).

Conclusions:

• The AA2R is not an effective screening tool for primary aldosteronism due to its inadequate diagnostic performance.
• Current ELISA-based renin-angiotensin system evaluations may lack the accuracy needed for reliable PA screening.
• Further research is needed to improve biochemical screening methods for PA.