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Submitted on June 28, 2004
Accepted on October 1, 2004
Department of Medicine, Queen Elizabeth Hospital, HKSAR, China
* To whom correspondence should be addressed.
Sau-Cheung TIU, E-mail: tscz01{at}ha.org.hk
Recent reviews recommended the use of the aldosterone/renin ratio (ARR) to screen for primary hyperaldosteronism. However, widely different cutoff levels have been proposed and test characteristics of ARR under different conditions of sampling are not known. We conducted a retrospective review among 45 subjects with carefully validated diagnoses of primary hyperaldosteronism and 17 subjects with essential hypertension to study the utility of ARR. 62 patients with 75 sets of plasma renin activity (PRA), aldosterone and ARR values from postural study and 48 sets of values from saline suppression test were analyzed. 94% of these subjects underwent investigations because of hypokalemic hypertension.
ARR yielded larger areas under curve in receiver operating characteristics curve than PRA or aldosterone under all conditions of testing. Our results confirmed the superiority of ARR to either aldosterone or PRA alone as a diagnostic test for primary hyperaldosteronism.
ARR cutoff levels were significantly affected by the condition of testing. Depending on posture and time of day, it varied from 13.1 to 35.0 ng/dL per ng/mL.h in our study population. When using ARR for screening primary hyperaldosteronism, posture and time of sampling should be standardized both within and between centers to minimize variability in cutoff levels.
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