BACKGROUND In many practices, the screening for primary aldosteronism relies on a single-blood draw for plasma aldosterone concentration (PAC) and plasma renin activity (PRA) to establish an aldosterone-to-renin ratio (ARR). ARR levels vary between expert centers and repeated assays in the same individual, emphasizing the potential variability of this screening approach. A suppressed PRA to <1 ng/mL per h has been proposed as an alternative test to the ARR. METHODS We compared 2 potential screening approaches to identify probable primary aldosteronism (ARR≥30 or ARR≥20 versus PRA suppressed below 1 ng/mL per h) in a cohort of 94 829 paired PRA and PAC samples submitted by clinicians to evaluate the presence of primary aldosteronism. RESULTS Of 94 829 patients, 20.3% tested positive based on ARR≥20 (95% CI, 20.0%-20.5%), 13.9% based on ARR≥30 (95% CI, 13.6%-14.1%), versus 45.9% based on suppressed PRA (<1 ng/mL per minute [95% CI, 45.5%-46.2%]). In the PRA group, a range of aldosterone levels was observed: 5.5% had PAC >15 ng/dL, 25.2% had PAC 5 to 15 ng/dL, and 15.2% had PAC <5 ng/dL, compared with 6%, 12.7%, and 1.6% in the ARR≥20 group and 4.7%, 8.5%, and 0.7% in the ARR≥30 group. CONCLUSIONS In this cohort of individuals being screened for primary aldosteronism, substantially more individuals were identified using criteria focused on suppression of renin activity compared with using the aldosterone renin ratio as a screening tool.

中文翻译：

---

比较 ARR 与抑制 PRA 作为原发性醛固酮增多症筛查试验。


背景技术在许多实践中，原发性醛固酮增多症的筛查依赖于单次抽血检测血浆醛固酮浓度(PAC)和血浆肾素活性(PRA)来建立醛固酮与肾素比率(ARR)。 ARR 水平因专家中心和同一个体的重复检测而异，强调了这种筛查方法的潜在可变性。已提出将 PRA 抑制至每小时 <1 ng/mL 作为 ARR 的替代测试。方法 我们比较了 2 种潜在的筛查方法，以确定可能的原发性醛固酮增多症（ARR≥30 或 ARR≥20 与 PRA 抑制在 1 ng/mL/h 以下），在临床医生提交的 94 829 配对 PRA 和 PAC 样本队列中，以评估是否存在原发性醛固酮增多症。结果 在 94 829 名患者中，20.3% 基于 ARR≥20（95% CI，20.0%-20.5%）检测呈阳性，13.9% 基于 ARR≥30（95% CI，13.6%-14.1%），而 45.9% 基于 ARR≥30（95% CI，13.6%-14.1%）。抑制 PRA（<1 ng/mL 每分钟 [95% CI，45.5%-46.2%]）。在 PRA 组中，观察到一系列醛固酮水平：5.5% 的 PAC >15 ng/dL，25.2% 的 PAC 5 至 15 ng/dL，15.2% 的 PAC <5 ng/dL，而这一比例为 6%。 ARR≥20 组为 12.7%、1.6%，ARR≥30 组为 4.7%、8.5%、0.7%。结论 在这群接受原发性醛固酮增多症筛查的个体中，与使用醛固酮肾素比率作为筛查工具相比，使用以抑制肾素活性为重点的标准发现了更多的个体。