Key result
ELISA-based AA2R underperforms ADRR for primary aldosteronism diagnosis, yielding an AUROC of ~0.75.
Why the study?
Primary aldosteronism is the most common but underdiagnosed form of hormonal hypertension, and the diagnostic performance of angiotensin II ELISA-based screening tests compared to aldosterone-to-direct renin ratio was unclear.
Does the aldosterone-to-angiotensin II ratio (AA2R) measured by ELISA improve diagnostic accuracy compared to the aldosterone-to-direct renin ratio (ADRR) for primary aldosteronism screening in hypertensive patients?
Cross-Sectional (n=100)
No
Does the aldosterone-to-angiotensin II ratio (AA2R) measured by ELISA improve diagnostic accuracy compared to the aldosterone-to-direct renin ratio (ADRR) for primary aldosteronism screening in hypertensive patients?
Absolute Event Rate: 0.754% vs 0.939%
p-value: p=<0.01
The aldosterone-to-angiotensin II ratio measured via ELISA has poor diagnostic accuracy compared to the standard aldosterone-to-direct renin ratio for primary aldosteronism screening.
Primary aldosteronism (PA) is the most common, but broadly underdiagnosed, form of hormonal hypertension. To improve screening procedures, current biochemical approaches aim to determine newly appreciated angiotensin II (Ang II) and calculate the aldosterone-to-angiotensin II ratio (AA2R). Thus, the aim of this study was to assess the diagnostic performance of these screening tests in comparison to the aldosterone-to-direct renin ratio (ADRR), which is routinely used. Cheap and available ELISA was used for Ang II measurement. To our knowledge, this is the first study of this laboratory method’s usage in PA. The study cohort included 20 PA patients and 80 controls. Ang II concentrations were comparable between PA and non-PA patients (773.5 vs. 873.2 pg/mL, p = 0.23, respectively). The AA2R was statistically significantly higher in PA group when compared with non-PA (0.024 vs. 0.012 ng/dL/pg/mL, p < 0.001). However, the diagnostic performance of the AA2R was significantly worse than that of the ADRR (AUROC 0.754 vs. 0.939, p < 0.01). The sensitivity and specificity of the AA2R were 70% and 76.2%, respectively. Thus, the AA2R was not effective as a screening tool for PA. Our data provide important arguments in the discussion on the unsatisfactory accuracy of renin−angiotensin system evaluation by recently repeatedly used ELISA tests.
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Łebek-Szatańska et al. (2022) conducted a cross-sectional in Primary aldosteronism (n=100). Aldosterone-to-angiotensin II ratio (AA2R) using ELISA vs. Aldosterone-to-direct renin ratio (ADRR) was evaluated on Diagnostic performance (AUROC) for primary aldosteronism (95% CI 0.657-0.834, p=<0.01). The aldosterone-to-angiotensin II ratio (AA2R) measured by ELISA had significantly worse diagnostic performance than the aldosterone-to-direct renin ratio (AUROC 0.754 vs. 0.939, p < 0.01).
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