| Primary aldosteronism(PA) is defined as an inappropriate and autonomous production of aldosterone by the adrenal glands, is one of the most common cause of secondary hypertension as endocrine disorder. Moreover, PA patients tend to experience more cardiovascular events than those with essential hypertension(EH). Therefore, an effective and timely screening test is urgently needed for PA treatment.The accuracy of aldosterone/direct renin concentration ratio(ADRR) as a screening test in patients with primary aldosteronism(PA) varies widely across the studies. We conducted a meta-analysis to assess the accuracy of ADRR. A literature search was performed in Pub Med, Embase and the Cochrane library between April 1971 and February 2016. Studies focusing on the accuracy of ADRR for PA screening were included. Two authors independently extracted information regarding patient characteristics, antihypertensives status, true positives, true negatives, false positives and false negatives. The random-effects model was used for statistical analysis. Heterogeneity was explored by subgroup analysis and meta-regression.Nine studies involving 974 patients were included. The overall sensitivity, specificity, area under the curve and diagnostic odds ratio of ADRR were 0.89(95%CI 0.84-0.93), 0.96(95%CI 0.95-0.98), 0.9853 and 324.13 respectively, with substantial heterogeneity. Meta-regression showed that antihypertensives status affects the ARR and may account for the heterogeneity(P=0.03). Subgroup analysis of patients who discontinued the antihypertensives revealed a sensitivity of 0.99(95%CI, 0.95-1.00) and a specificity of 0.98(95%CI, 0.96-0.99).This study demonstrates the efficacy of ADRR as a screening test for primary aldosteronism. However, as antihypertensive drugs can interfere with the interpretation of ADRR it is recommended to interrupt therapy or at least replace with analogues that do not significantly affect the ADRR value. |
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