Screening for primary aldosteronism on and off interfering medications

Area of Science:

• Endocrinology
• Clinical Diagnostics
• Hypertension Management

Background:

• Primary aldosteronism (PA) is a common cause of secondary hypertension.
• Accurate screening for PA is crucial for timely diagnosis and treatment.
• The aldosterone-to-renin ratio (ARR) is a key screening biomarker, but its accuracy may be affected by antihypertensive medications.

Purpose of the Study:

• To evaluate the clinical relevance of antihypertensive drug interference on the diagnostic accuracy of the aldosterone-to-renin ratio (ARR) for primary aldosteronism (PA).
• To determine optimal ARR thresholds for PA screening in patients taking antihypertensive medications.

Main Methods:

• Retrospective and prospective cohorts included patients with PA and essential hypertension (EH).
• Confirmatory tests were used to diagnose PA.
• Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of ARR were calculated with and without interfering medications.

Main Results:

• AUC of ARR was comparable between patients on and off interfering medications (retrospective: 0.82 vs. 0.87; prospective: 0.78 vs. 0.84).
• At a threshold of 20 pg/μIU, ARR sensitivity was lower and specificity higher on interfering medications.
• Lowering the ARR threshold to 10 pg/μIU resulted in comparable sensitivity and specificity to that off interfering medications.

Conclusions:

• Screening for PA using ARR is feasible in patients taking interfering antihypertensive drugs.
• Reducing the ARR threshold to 10 pg/μIU is recommended when patients are on interfering medications.
• This adjustment ensures reliable PA screening without necessitating medication withdrawal in most cases.