The Evidence-based Evaluation Of Assays Of ARR For Primary Aldosteronism

ObjectivePrimary aldosteronism (PA) was a common form of endocrine hypertension, characterized by inappropriate and relatively autonomous production of aldosterone. More and more studies have demonstrated that patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential hypertension and the same degree of blood pressure elevation[5]. However, PA was the most common identifiable, specifically treatable, good prognostic and potentially curable form of hypertension and the diagnostic work-up to timely identify PA will be increasingly used by physician. It could be diagnosed by screening and confirmed tests. As to the screening test, ARR(aldosterone-renin ratio) has been recommended all over the world. There were many assay methods for the ARR. However, different labs had different opinions. It was not convenient for communicating and comparing. Therefore, this study is done to evaluate whether the assays of ARR fufill the criteria of evidence-based medicine and recommend a better method of ARR assay.MethodsWe carried out a systematic literature search of guidelines(GLs) on PA, hypertension, resistant hypertension, adrenal incidentaloma and articles of the assay methods of ARR. We applied the following inclusion and exclusion criteria to screening the relevant GLs and original articles and extracted data on the ARR cut-off value and assays. Then we applied the software of Metadisc to analyze the statistics. ResultsOf 3408 references,there was only one guideline referring to the assays of ARR. including chemiluminescence-immunoassay, radioimmunoassay and tandem mass spectromercy assay.Of 2481 screening articles,19 articles were anlyzed by the software of Metadisc.They were radioimmunoassay. As to the chemiluminescence-immunoassay and tandem mass spectrometry assay, there was respectively only one article.So we did not analyze it.ConclusionsThe assays of ARR did not fulfill the criteria of evidence-based medicine. As for the sensitivity and specificity, radioimmunoassay was better than chemiluminescence-immunoassay. But the latter's consistency was better. The tandem mass spectrometry assay was used to measure the plasma concentrations of aldosteronism and renin.