Key result
One-hour captopril challenge test fails to replace standard 2-hour sampling for diagnosing primary aldosteronism.
Why the study?
The consistency between 1-h and 2-h plasma aldosterone concentrations in the captopril challenge test and whether 1-h sampling can replace 2-h sampling to diagnose primary aldosteronism were unclear.
Observational (n=204)
No
Retaining 2-hour sampling remains necessary for accurate primary aldosteronism diagnosis; retrospective data leave open prospective assessment of abbreviated protocols.
Objective: To examine the consistency of plasma aldosterone concentration at 1 and 2 h in the captopril challenge test (CCT) and to explore the possibility of replacing 2-h aldosterone concentration with 1-h aldosterone concentration for diagnosis of primary aldosteronism (PA). Methods: This retrospective analysis included a total of 204 hypertensive patients suspected of having PA. Subjects received oral captopril challenge at 50 mg (25 mg if the systolic blood pressure was <120 mmHg), and plasma aldosterone concentration and direct renin concentration were measured at 1 and 2 h afterward (chemiluminescence immunoassay Liaison® DiaSorin, Italy). Sensitivity and specificity were used to reflect the diagnostic performance of 1-h aldosterone concentration using 2-h aldosterone concentration (11 ng/dl as the cutoff) as the reference. A receiver operating characteristic curve analysis was also conducted. At a cutoff of 11 ng/dl, the sensitivity and specificity of using 1-h aldosterone concentration to diagnose PA were 87.2% and 78.2%, respectively. A higher cutoff of 12.5 ng/ml increased specificity to 90.0% but decreased sensitivity to 75.5%. A lower cutoff of 9.3 ng/ml increased sensitivity to 97.9% but decreased specificity to 65.4%. Conclusions: When diagnosing PA with CCT, 1-h aldosterone concentration could not be used to replace 2-h aldosterone concentration.
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Liu et al. (2023) conducted an observational in Primary aldosteronism and hypertension (n=204). 1-hour plasma aldosterone concentration in the captopril challenge test vs. 2-hour plasma aldosterone concentration (>11 ng/dl as reference standard) was evaluated on Diagnostic accuracy (sensitivity and specificity at a cutoff of 11 ng/dl) and AUROC of 1-hour plasma aldosterone concentration for diagnosing primary aldosteronism (AUROC 0.905, 95% CI 0.856-0.942). 1-hour plasma aldosterone concentration in the captopril challenge test achieved 87.2% sensitivity and 78.2% specificity (at 11 ng/dl cutoff) and could not replace 2-hour sampling for diagnosing PA.
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