Context: The aldosterone to active renin ratio (AARR) is the recommended screening test for primary aldosteronism (PA), but prospective study data on its sensitivity and specificity are sparse.
Objective: We investigated the diagnostic accuracy of the AARR for detecting PA.
Design: This is a prospective diagnostic accuracy study.
Setting: This study was conducted from February 2009 to August 2015 at the outpatient clinic of the Department of Endocrinology and Diabetology of the Medical University of Graz, Austria.
Participants: We included 400 patients with arterial hypertension who were referred to our tertiary care center for screening for endocrine hypertension.
Intervention: Participants had a determination of the AARR (index test) and a second AARR determination followed by a saline infusion test (SIT) after 2 two 6 weeks. PA was diagnosed in individuals with any AARR of ≥3.7 ng/dl/μU/ml (including a plasma aldosterone concentration [PAC] of ≥9 ng/dl) who had a PAC of ≥10 ng/dl after the SIT. We did not substantially alter antihypertensive drug intake.
Main outcome measures: Primary outcome was the receiver operating characteristic (ROC) curve of the AARR in diagnosing PA.
Results: Eligible for analyses were 382 participants and PA was diagnosed in 18 patients (4.7%). The area under the ROC curve of the AARR in detecting PA was 0.973 (95% confidence interval [CI]: 0.9560.990). Sensitivity and specificity for a positive AARR in diagnosing PA was 100% (95% CI: 81.5100.0) and 89.6% (95% CI: 86.092.5), respectively.
Conclusions: The AARR has a good diagnostic accuracy for detecting PA.
18 - 21 May 2019
European Society of Endocrinology