Key result
Oral furosemide 80 mg yields ~90% diagnostic accuracy for primary aldosteronism at 2 hours.
Why the study?
Confirmatory tests for primary aldosteronism diagnosis are fundamental but laborious and often require a hospital setting due to associated risks.
Does an 80 mg oral furosemide test accurately confirm the diagnosis of primary aldosteronism in patients with hypertension?
Observational (n=86)
No
Does an 80 mg oral furosemide test accurately confirm the diagnosis of primary aldosteronism in patients with hypertension?
Answers are grounded in this paper and cite their sources.
An 80 mg oral furosemide dose provides a safe, highly accurate, and outpatient-friendly alternative confirmatory test for diagnosing primary aldosteronism.
Context: Confirmatory tests represent a fundamental step in primary aldosteronism (PA) diagnosis, but they are laborious and often require a hospital environment due to the risks involved. Objective: To evaluate the efficacy of oral furosemide as a new confirmatory test for PA diagnosis. Methods: We prospectively evaluated the diagnostic performance of 80 mg of oral furosemide in 64 patients with PA and 22 with primary hypertension (controls). Direct renin concentration (DRC) was measured before, and 2 hours and 3 hours after the oral furosemide. In addition, the oral furosemide test was compared with 2 other confirmatory tests: the furosemide upright test (FUT) and saline infusion test (SIT) or captopril challenge test (CCT) in all patients with PA. Results: The cut-off of 7.6 µU/mL for DRC at 2 hours after oral furosemide had a sensitivity of 92%, specificity of 82%, and accuracy of 90% for PA diagnosis. In 5 out of 6 controls with low-renin hypertension, which might represent a PA spectrum, renin remained suppressed. Excluding these 6 controls with low-renin hypertension, the DRC cut-off of 10 µU/mL at 2 hours after oral furosemide had a sensitivity of 95.3%, specificity of 93.7% and accuracy of 95% for PA diagnosis. DRC after 3 hours of oral furosemide did not improve diagnostic performance. Using the cut-off of 10 µU/mL, the oral furosemide test and the FUT were concordant in 62 out of 64 (97%) patients with PA. Only 4 out of 64 cases with PA (6.4%) ended the oral furosemide test with potassium <3.5 mEq/L. Hypotension was not evidenced in any patient with PA during the test. Conclusion: The oral furosemide test was safe, well-tolerated and represents an effective strategy for PA investigation.
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Freitas et al. (2023) conducted an observational in Primary Aldosteronism and Primary Hypertension (n=86). Oral furosemide vs. Intravenous furosemide upright test and primary hypertension controls was evaluated on Direct renin concentration (DRC) cut-off of 7.6 µU/mL at 2 hours after oral furosemide for diagnosis of primary aldosteronism (Sensitivity 92%, Specificity 82%, Accuracy 90%). Oral furosemide 80 mg demonstrated a sensitivity of 92% and specificity of 82% for the diagnosis of primary aldosteronism using a direct renin concentration cut-off of 7.6 µU/mL at 2 hours.
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