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Screening primary aldosteronism by plasma aldosterone-to-angiotensin II ratio
Clara Wai-Shan Lo1, Jenny Yeuk-Ki Cheng1, Teresa Kam-Chi Tsui1
1Department of Chemical Pathology, 26451 The Chinese University of Hong Kong, Prince of Wales Hospital , Statin, NT, Hong Kong.
Clinical Chemistry and Laboratory Medicine
|April 4, 2025
Summary
The aldosterone-to-angiotensin II ratio (AAIIR) shows promise as an alternative screening tool for primary aldosteronism (PA). This new ratio demonstrated diagnostic performance comparable to the current aldosterone-to-renin ratio (ARR) in hypertensive patients.
Area of Science:
- Endocrinology
- Hypertension Research
- Biomarker Discovery
Background:
- Primary aldosteronism (PA) is a frequent cause of secondary hypertension.
- The aldosterone-to-renin ratio (ARR) is the standard screening biomarker for PA.
- Current ARR screening methods have recognized limitations.
Purpose of the Study:
- To evaluate the aldosterone-to-angiotensin II ratio (AAIIR) as a potential alternative screening biomarker for PA.
- To compare the diagnostic performance of AAIIR against the established ARR.
Main Methods:
- Retrieved archived plasma samples from 152 hypertensive patients undergoing PA screening.
- Measured both AAIIR and ARR using liquid chromatography-mass spectrometry.
- Performed correlation, sensitivity, specificity, and ROC curve analyses to assess diagnostic accuracy.
Main Results:
- AAIIR demonstrated a strong positive correlation with ARR (r=0.79, p<0.0001).
- The diagnostic performance (Area Under Curve) of AAIIR (0.94) was comparable to ARR (0.94, p=0.877).
- AAIIR showed slightly higher sensitivity (91% vs. 88%) and comparable specificity (85% vs. 86%) versus ARR.
Conclusions:
- AAIIR exhibits diagnostic performance comparable to ARR for PA screening.
- AAIIR may offer advantages in efficiency and reliability over ARR.
- Further large-scale studies are required to validate AAIIR for routine clinical use.
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