Key result
Malignant hypertension is linked to ~15.2-fold higher odds of false-negative ARR screening in coexisting RAS and aldosteronism.
Why the study?
To investigate changes in the aldosterone-to-renin ratio and other influencing factors in patients with renal artery stenosis and primary aldosteronism.
Do malignant hypertension and severe renal artery stenosis contribute to false-negative primary aldosteronism screening results in patients with comorbid RAS and PA?
Cohort (n=78)
No
Do malignant hypertension and severe renal artery stenosis contribute to false-negative primary aldosteronism screening results in patients with comorbid RAS and PA?
In patients with comorbid renal artery stenosis and primary aldosteronism, severe RAS and malignant hypertension frequently cause false-negative aldosterone-to-renin ratio screening results, demonstrating the need for re-testing after renal revascularization.
We conducted a retrospective cohort study to investigate changes in the aldosterone-to-renin ratio (ARR) and other influencing factors in patients with renal artery stenosis (RAS) and primary aldosteronism (PA). Patients with RAS and PA admitted to our hospital between January 2016 and December 2021 were retrospectively selected. Based on the standardized PA screening results, the patients were divided into aldosterone-to-renin ratio-positive and -negative groups. The clinical features of the patients were compared. Binary logistic regression analysis was performed to identify the factors contributing to the comorbidity of RAS with false-negative PA. A total of 78 patients (mean age: 60.2 ± 10.2 years) were selected, among whom 46 (59%) were male. Overall, 69 patients had Stage 3 hypertension (88.5%) and 57 had hypokalemia (73.1%). Additionally, 42 (53.8%) and 36 (46.2%) patients were aldosterone-to-renin ratio-positive and -negative, respectively. The aldosterone-to-renin ratio-positive group showed significant differences in malignant hypertension (2.4% vs. 27.8%; p = 0.002), Stage 3 hypertension (81.0% vs. 97.2%; p = 0.033), and RAS degree (64.3 ± 16.4% vs. 71.8 ± 14.4%; p = 0.032). Malignant hypertension (odds ratio, 15.250; 95% confidence interval, 1.787-130.132; p = 0.013) and RAS degree (odds ratio, 1.034; 95% confidence interval, 1.002-1.068; p = 0.036) influenced the comorbidity of RAS with false-negative PA. Malignant hypertension and severe RAS can contribute to false-negative PA results. Therefore, PA screening test results should be carefully analyzed and rechecked following RAS treatment to confirm the presence of PA.
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Wang et al. (2025) conducted a cohort in Renal artery stenosis and primary aldosteronism (n=78). Malignant hypertension vs. Non-malignant hypertension was evaluated on False-negative aldosterone-to-renin ratio (ARR) screening result for primary aldosteronism (OR 15.250, 95% CI 1.787-130.132, p=0.013). In patients with comorbid renal artery stenosis and primary aldosteronism, malignant hypertension was significantly associated with false-negative aldosterone-to-renin ratio screening results (OR 15.250).
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