Optimal Cut-Off Values of the Aldosterone-Renin Ratio in Different Age Groups for Primary Aldosteronism Screening

This study sought to establish age-specific optimal cut-off values for the aldosterone-to-renin ratio (ARR) in screening for primary aldosteronism (PA). The analysis included 281 patients with confirmed PA and 1242 with essential hypertension (EH), categorized into four age groups: ≤39, 40-49, 50-59, and ≥60 years. A positive correlation was observed between ARR and age in both patient groups. Receiver operating characteristic analysis determined the optimal ARR cut-offs to be 2.3, 2.8, 3.1, and 3.6 for the respective age groups, with all demonstrating high diagnostic accuracy. Further evaluation revealed that for patients under 50-years-old, a unified ARR cut-off of 2.4 provided high sensitivity and specificity, while for patients aged 50 or older, a cut-off of 3.7 was more appropriate. In conclusion, the optimal ARR cut-off for PA screening increases with age, and we recommend using a value of 2.4 for patients under 50 and 3.7 for those aged 50 or older to achieve superior diagnostic performance.