What question did this study set out to answer?

This study examines the effectiveness of the plasma aldosterone-to-renin activity ratio (ARR) for diagnosing primary aldosteronism in treated African American and white individuals with resistant hypertension.

June 1, 2005American Journal of Hypertension

Validity of Plasma Aldosterone-to-Renin Activity Ratio in African American and White Subjects With Resistant Hypertension

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Why the study?

Is the plasma aldosterone-to-renin activity ratio (ARR) a valid screening test for primary aldosteronism in African American and white subjects with resistant hypertension?

Key Points

This study examines the effectiveness of the plasma aldosterone-to-renin activity ratio (ARR) for diagnosing primary aldosteronism in treated African American and white individuals with resistant hypertension.
Prospective evaluation of the plasma aldosterone-to-renin ratio in treated resistant hypertension subjects.
Assessment included early morning ARR and 24-h urinary aldosterone and sodium measurements.
Defined primary aldosteronism by specific criteria related to plasma renin activity and urinary aldosterone excretion.
In 58 subjects, primary aldosteronism was confirmed in 45, with an ARR sensitivity of 78% and specificity of 83%.
Positive predictive value was 56% and negative predictive value was 93%.
Sensitivity among African Americans was 75% compared to 80% for whites, with respective negative predictive values of 92% and 94%.

Structured PICO

Is the plasma aldosterone-to-renin activity ratio (ARR) a valid screening test for primary aldosteronism in African American and white subjects with resistant hypertension?

Population

265 African American and white subjects with resistant hypertension on stable antihypertensive treatments referred to a university hypertension clinic.

Intervention

Plasma aldosterone-to-renin activity ratio (ARR) screening

Comparator

24-h urinary aldosterone and sodium (suppressed PRA <1.0 ng/mL/h and elevated urinary aldosterone excretion >12 microg/24 h during high dietary sodium ingestion >200 mEq/24 h)

Outcome

Diagnostic validity (sensitivity, specificity, positive predictive value, negative predictive value) of ARR for primary aldosteronismsurrogate

The ARR is a valid screening test for primary aldosteronism in treated resistant hypertension patients with high negative predictive value, though its high false-positive rate precludes it as a definitive diagnostic tool.

Limitations

High percentage of false-positive results precludes using it for accurate diagnosis

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Supports ARR screening in resistant hypertension given high NPV; leaves open definitive diagnosis in observational cohorts.

Cite This Study

Nishizaka et al. (2005) studied this question.

synapsesocial.com/papers/6a6f3eb52163a0a01bc39232 https://doi.org/10.1016/j.amjhyper.2005.01.002

Topics

Hypertension management

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Validity of Plasma Aldosterone-to-Renin Activity Ratio in African American and White Subjects With Resistant Hypertension

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Topics

Validity of Plasma Aldosterone-to-Renin Activity Ratio in African American and White Subjects With Resistant Hypertension

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider