Key result
ARR screening yields high diagnostic accuracy for primary aldosteronism with ~93% specificity in hypertension.
Why the study?
ARR is commonly used to screen for primary aldosteronism in difficult-to-control hypertension, but varying confirmatory test thresholds have led to inconsistent results.
Does the aldosterone-to-renin ratio (ARR) accurately screen for primary aldosteronism in hypertensive patients?
Meta-Analysis (n=7,150)
Does the aldosterone-to-renin ratio (ARR) accurately screen for primary aldosteronism in hypertensive patients?
Odds Ratio: 62 (95% CI 33.3–115.3)
The aldosterone-to-renin ratio is a highly accurate and viable screening tool for primary aldosteronism in hypertensive patients, with consistent diagnostic performance across diverse clinical contexts and measurement methods.
ARR supports expanded primary aldosteronism screening in hypertension; confirms high diagnostic performance and strengthens guideline recommendations.
Background: The aldosterone-to-renin ratio (ARR) is commonly used for screening primary aldosteronism (PA) in patients with difficult-to-control hypertension. Various thresholds have been proposed for the confirmatory tests, leading to inconsistency in the results. Objectives: This study aimed to elucidate the performance of ARR screening in hypertensive patients. Design: Systemic review and meta-analysis. Data sources and methods: PubMed, Embase, and the Cochrane Library were systematically searched from inception to January 2024. Studies that used the ARR to screen for PA and provided a comprehensive probability panel specifically focusing on hypertensive individuals were considered for enrollment. Pooled diagnostic efficacy was evaluated, and subgroup analyses and meta-regression were conducted based on different demographic and clinical parameters. Results: Eighteen observational studies encompassing 7150 participants were included in the meta-analysis. The overall prevalence of PA in the hypertensive cohort was 15.2%, and pooled sensitivity and specificity were 81.6% and 93.3%, respectively, resulting in a diagnostic odds ratio of 62.0. Fagan's nomogram showed that a positive ARR increased the post-test probability to 80% from a pre-test probability of 25%. Summary receiver operating characteristic curve analysis revealed an area under the curve of 94.7%. Notably, analysis of variability demonstrated that the diagnostic performance was consistent across either ARR based on plasma renin activity or direct renin concentration, geographic region, sex, mean age, potassium level, and systolic blood pressure. Conclusion: ARR was validated as a viable screening methodology for PA in hypertensive individuals. Moreover, its diagnostic efficacy remained unchanged across diverse clinical contexts. Future studies are warranted to refine ARR methodologies and enhance diagnostic accuracy. Trial registration: PROSPERO ID number CRD42023493680. Infographics: ARR, aldosterone-to-renin ratio; BP, blood pressure; DRC, direct renin concentration; hsROC, hierarchical summary receiver operating characteristic; PA, primary aldosteronism; PRA, plasma renin activity.
No takes yet. Share an insight, caveat, or question.
Kao et al. (2024) conducted a meta-analysis in Hypertension (screening for primary aldosteronism) (n=7,150). Aldosterone-to-renin ratio (ARR) screening vs. Confirmatory tests for primary aldosteronism was evaluated on Diagnostic efficacy (diagnostic odds ratio) of ARR for primary aldosteronism (DOR 62.0, 95% CI 33.3-115.3). Aldosterone-to-renin ratio screening for primary aldosteronism in hypertensive patients demonstrated a pooled sensitivity of 81.6%, specificity of 93.3%, and a diagnostic odds ratio of 62.0.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: