Comparing ARR Versus Suppressed PRA as Screening Tests for Primary Aldosteronism

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.