Key result
Captopril challenge test using ARR >200 identifies primary aldosteronism in ~70% of patients.
Why the study?
The captopril challenge test presents false-negative results, and it remains inconclusive which of the many diagnostic criteria to use for primary aldosteronism.
Does the captopril challenge test using ARR >200 improve diagnostic reliability in patients with primary aldosteronism?
Observational (n=71)
No
Does the captopril challenge test using ARR >200 improve diagnostic reliability in patients with primary aldosteronism?
p-value: p=0.15
An aldosterone/renin ratio >200 after the captopril challenge test is a valuable criterion for diagnosing primary aldosteronism, as it yields the highest positive rate and is less influenced by sodium intake.
ARR >200 post-CCT may detect more PA cases in observational cohorts; leaves open optimal confirmatory criteria pending prospective validation.
INTRODUCTION: The captopril challenge test (CCT) is the major confirmatory test for primary aldosteronism (PA), and frequently carried out because of its convenience. However, it presents false-negative results with a certain probability, and as there are many criteria for CCT, it is not concluded yet which criteria to use. MATERIALS AND METHODS: A total of 71 PA patients were evaluated. We compared CCT-positive and CCT-negative patients in the following three criteria: plasma aldosterone/renin ratio (ARR) >200 after the CCT (criterion 1); plasma aldosterone concentration (PAC) >120 pg/ml after the CCT (criterion 2); and PAC suppression <30% of PAC before CCT (criterion 3). RESULTS: The positive rate was 70.4%, 64.8% and 54.9% for criterion 1, criterion 2 and criterion 3, respectively. With criterion 1, the baseline plasma renin activity was lower, thus baseline ARR was higher in CCT-positive patients. With criterion 2, PAC was higher and estimated sodium intake and K were lower in CCT-positive patients. With criterion 3, K and PAC were lower in CCT-positive patients. Although it was not significant, in the patients with high sodium intake, the positive rate of criterion 1 was higher than that of the other criteria. CONCLUSIONS: ARR>200 is the valuable criterion for the diagnosis of PA.
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Kidoguchi et al. (2019) conducted an observational in Primary aldosteronism (n=71). Captopril challenge test (CCT) criteria vs. Alternative CCT criteria was evaluated on Positive rate of CCT criteria (Criterion 1: ARR >200, Criterion 2: PAC >120 pg/ml, Criterion 3: post PAC >0.7 x pre PAC) (p=0.15). The captopril challenge test using the criterion of aldosterone/renin ratio >200 yielded a positive rate of 70.4% in primary aldosteronism patients, making it the most valuable criterion as it was less influenced by sodium intake.
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