Screening for Primary Aldosteronism without stopping antihypertensive medications

1. Title of the Article:

Performance of Aldosterone-to-renin Ratio Before Washout of Antihypertensive Drugs in Screening of Primary Aldosteronism

2. First Two Authors Followed by et al:

Xinyu Liu, Sufang Hao et al.

3. One-Line Summary of the Article:

The study evaluates the performance of aldosterone-to-renin ratio (ARR) as a sensitive and specific screening test for primary aldosteronism (PA) without discontinuing antihypertensive drugs.

4. Six Key Points from the Article:

1. Background: PA is a common, treatable form of secondary hypertension, with ARR being the standard screening test. However, drug washout is often required, posing clinical risks.

2. Objective: Assess the efficacy of ARR screening without discontinuation of antihypertensive medications.

3. Study Design: Retrospective analysis of 1,306 patients screened for PA, comparing ARR before and after drug washout.

4. Key Findings: At a cutoff of 0.7 (ng/dL)/(μIU/mL), ARR before washout showed 96.3% sensitivity, 61.2% specificity, 0.33 PPV, and 0.99 NPV.

5. Subgroup Analysis: Sensitivity was higher in patients on β-blockers (98.3%) compared to those not on β-blockers (93.9%).

6. Conclusion: ARR without drug washout is a reliable screening tool for PA, with high sensitivity and acceptable specificity.

5. Practical Take-Home Message:

ARR can be effectively used for screening PA without stopping antihypertensive drugs, minimizing the risk of complications associated with drug withdrawal. A cutoff of ≤0.7 (ng/dL)/(μIU/mL) reliably excludes PA, simplifying patient management.

6. Citation for the Article in Vancouver Format:

Liu X, Hao S, Bian J, Lou Y, Zhang H, Wu H, et al. Performance of Aldosterone-to-renin Ratio Before Washout of Antihypertensive Drugs in Screening of Primary Aldosteronism. J Clin Endocrinol Metab. 2024;109(12):e2302–e2308. doi:10.1210/clinem/dgae094

7. Toolkit

You can find the tool to help you in the calculation here: Liu-Hao Tool