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Diagnosis of primary aldosteronism: Comparison of post-captopril active renin concentration and plasma renin activity |
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| Authors: | Vin-Cent Wu Chin-Chi Kuo Hung-Wei Chang Chia-Ti Tsai Chien-Yu Lin Lian-Yu Lin Yen-Hung Lin Shuo-Meng Wang Kuo-How Huang Cheng-Chung Fang Yi-Luwn Ho Kao-Lang Liu Chin-Chen Chang Shih-Chieh Chueh Shuei-Liong Lin Ruoh-Fang Yen Kwan-Dun Wu |
| Institution: | 1. Instituto de Física, Universidade Federal Fluminense, Av. Gal. Milton Tavares de Souza, S/N, Niterói, 24210-346, RJ, Brazil;2. Núcleo de Estudos do Mar, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, 88040-900, SC, Brazil;3. Departamento de Ciências da Natureza, Universidade do Estado do Rio de Janeiro, Rua Santa Alexandrina, 288, Rio de Janeiro, 20261-232, RJ, Brazil;4. Instituto Superior de Tecnologías y Ciencias Aplicadas, InSTEC, Quinta de los Molinos, Ave. Salvador Allende y Luaces, Plaza de la Revolución, Ciudad de La Habana, Cuba;5. Departamento de Biologia Marinha, Instituto de Biologia Universidade Federal Fluminense, Niterói, RJ, Brazil;1. School of Medicine, Vanderbilt University, Nashville, TN, USA;2. Division of Pediatric Endocrinology, Vanderbilt University, Nashville, TN, USA;3. Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA |
| Abstract: | BackgroundA common pharmacologic test for the diagnosis of primary aldosteronism (PA) is the administration of captopril to determine whether an abnormal plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio(ARR) persists, although active renin concentration (ARC) may offer advantages with regard to processing and standardization.MethodsA prospective, head-to-head study was conducted between Feb 2008 and Dec 2008. One hundred and fourteen patients enrolled and received captopril to aid in the diagnosis of PA in the TAIPAI intervention.ResultsFifty-one patients were diagnosed with PA. Post-captopril ARC was significantly correlated with PRA. The area under the receiver operating characteristic curve of the post-captopril ARR was not different in PRA vs ARC measurements. When post-captopril ARC-based ARR (ARRARC) > 35.5 as the cut-off value, we obtained sensitivity of 75.0% and specificity of 86.4% to differentiate PA from essential hypertension.ConclusionsThe correlation of individual PRA and ARC after administration of captopril was excellent; especially at the lower PRA levels. Post-captopril ARRARC values used to diagnose PA are not different from post-captopril PRA-based (ARRPRA) values in patients without kidney, liver and heart failures. Primary aldosteronism can be diagnosed with a post-captopril cut-off value of ARRARC > 35.5 pmol/ng. |
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