Clinical Significance Of Aldosterone To Renin Ratio In Screening Primary Aldosteronism

Objective: In recent years,the assessment of the plasma aldostemne-to-renin ratio (ARR)has become a every effective and widely used method for screening primaryaldosteronism from hypertensives． It is well known that there is a large variance in ARRvalue between different races and region, Meanwhile ARR can be affected by manyfactors,such as drugs,posture and detection time etc．The receiver operating characteristic(ROC) curve was used to evaluate the value of aldosterone to renin ratio (ARR) inscreening primary aldosteronism.Methods: The clinical data of ARR in supine and upright positions were collected from301patients who is suspected has primary aldosteronism during March2012to September2013. supine and upright ARR detection and Saline infusion test were performed for allthe participants.105patients were diagnosed primary aldosteronism and196patientswere essential hypertension among all participants. Gender, age, the course ofhypertension, BMI, systolic blood pressure, diastolic blood pressure, serum sodium,potassium, urinary sodium, urinary potassium, supine PRA, upright PRA, supine PAC,upright clinical data PAC, supine ARR, upright ARR were collected for statistical analysis.At last use the ROC curve to define the best cut-off value of ARR for screening primaryaldosteronism from hypertensives．Results: In the analysis of the clinical data of PA group and EH group, We find the iteamsof supine/upright PAC, ARR levels in EH group were lower than that of PA group, andthe supine/upright plasma PRA was higher than that of PA group, the difference both havestatistical significance((P＜0.05)； the area under the ROC curve of supine ARR is0.763 (0.717-0.813), the area under the ROC curve of upright ARR is0.909(0.868-0.941),there was significantly difference between these two areas under the ROC curve (P<0.01)；the area under the ROC curve of upright PRA is0.814(0.762-0.859), the area under theROC curve of upright PAC is0.684(0.625-0.074), there was significantly differencebetween these two areas under the ROC curve (P＜0.05)；The statistical analysis of thearea under the ROC curve of the upright ARR、supine ARR、upright PRA、upright PAC,upright ARR show that the Z of the upright ARR(Z=4.663) is higher, the difference hasstatistical significance((P<0.01)； The upright ARR cut-off value with240(pg/ml/ng ml-1h-1) yielded a sensitivity of100％and a specificity of74.09％to diagnosis ofPA．Conclusion: In our research,under strict consol of the drug,position and detectiontime,Upright ARR value was more suitable in the screening test than supine ARR. It issuitable to use upright ARR240(pg/ml/ng ml-1h-1) as a cut-off threshold forscreening primary aldostemnism in hypenensives．...