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Validity of plasma aldosterone-to-renin activity ratio in African American and white subjects with resistant hypertension.

Abstract：

BACKGROUND:Recent reports suggesting that primary aldosteronism (PA) is more common than historically thought have often relied on use of the plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio (ARR) to identify patients with PA. Prior determinations of the validity of the ARR had been generally limited to subjects that could be withdrawn from antihypertensive therapy and to non-African American subjects. METHODS AND RESULTS:The current study was designed to evaluate prospectively the diagnostic value of the ARR in treated African American and white subjects with resistant hypertension. Consecutive subjects referred to a university hypertension clinic for resistant hypertension were evaluated with an early morning ARR and a 24-h urinary aldosterone and sodium. The presence of PA was defined as a suppressed PRA (<1.0 ng/mL/h) and elevated urinary aldosterone excretion (>12 microg/24 h) during high dietary sodium ingestion (>200 mEq/24 h). In 58 subjects, PA was confirmed. The ARR was elevated (>20) in 45 of 58 subjects with PA and in 35 of the 207 patients without PA, resulting in a sensitivity of 78% and specificity of 83% with a corresponding positive predictive value of 56% and a negative predictive value of 93%. Among African American subjects, the ARR was less sensitive than in white subjects (75% v 80%), but it still had a high negative predictive value (92% v 94%). CONCLUSIONS:These data indicate that the ARR is valid as a screening test for PA in African American and white patients on stable antihypertensive treatments, but a high percentage of false-positive results precludes using it for accurate diagnosis of PA.

journal_name

Am J Hypertens

journal_title

American journal of hypertension

authors

Nishizaka MK,Pratt-Ubunama M,Zaman MA,Cofield S,Calhoun DA

doi

10.1016/j.amjhyper.2005.01.002

subject

Has Abstract

pub_date

2005-06-01 00:00:00

pages

805-12

issue

6

eissn

0895-7061

issn

1941-7225

pii

S0895-7061(05)00043-9

journal_volume

18

pub_type

杂志文章

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