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Comparing ARR Versus Suppressed PRA as Screening Tests for Primary Aldosteronism.

Marco Marcelli1, Caixia Bi1, John W Funder2

  • 1Quest Diagnostics Nichols Institute, San Juan Capistrano, CA (M.M., C.B., M.J.M.).

Hypertension (Dallas, Tex. : 1979)
|July 23, 2024
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Summary

Screening for primary aldosteronism using suppressed plasma renin activity (PRA) identified significantly more individuals than the aldosterone-to-renin ratio (ARR). This suggests suppressed PRA may be a more sensitive screening tool for primary aldosteronism.

Keywords:
aldosterone renin ratiohypertensionplasma renin activityprimary aldosteronismsecondary hypertension

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Area of Science:

  • Endocrinology
  • Clinical Diagnostics
  • Hypertension Research

Background:

  • Primary aldosteronism screening often uses the aldosterone-to-renin ratio (ARR) from a single blood draw.
  • ARR variability and assay inconsistencies highlight potential limitations of this screening method.
  • Suppressed plasma renin activity (PRA) below 1 ng/mL/h is proposed as an alternative screening approach.

Purpose of the Study:

  • To compare the effectiveness of suppressed PRA versus ARR in identifying probable primary aldosteronism.
  • To evaluate two screening strategies in a large cohort of patients undergoing primary aldosteronism testing.

Main Methods:

  • A retrospective analysis of 94,829 paired plasma renin activity (PRA) and plasma aldosterone concentration (PAC) samples.
  • Comparison of screening criteria: ARR (≥20 or ≥30) versus suppressed PRA (<1 ng/mL/h).

Main Results:

  • Suppressed PRA identified 45.9% of patients, significantly higher than ARR≥20 (20.3%) or ARR≥30 (13.9%).
  • The PRA group exhibited a wide range of aldosterone levels, indicating diverse underlying conditions.
  • Lower percentages of patients met ARR criteria compared to suppressed PRA criteria.

Conclusions:

  • Screening for primary aldosteronism using suppressed PRA criteria identifies substantially more individuals than ARR-based methods.
  • Suppressed PRA may serve as a more sensitive initial screening tool for primary aldosteronism in large clinical cohorts.