Value of renin and aldosterone of upright and supine positions in diagnosis of primary aldosteronism in hypertension patients

  AIM  To determine the cut-off value of plasma aldosterone concentration (PAC) and plasma renin concentration (PRC) of upright and supine positions for primary aldosteronism (PA) screening to improve the diagnostic accuracy of PA.

  METHODS  We retrospectively analyzed 240 suspected PA patients by confirmed diagnosis of primary hypertension (PH) in our hospital from 2018 to 2019. All patients received in-hospital captopril test and intravenous saline load test as confirmed diagnosis test for PA. The area under the curve of receiver operating characteristic (AUC_ROC) was applied to evaluate PAC and the ratio of aldosterone/renin (RAA) to obtain the best cut-off point with the corresponding sensitivity and specificity for PA diagnosis.

  RESULTS  AUCROC for supine and upright ARR were 0.916 and 0.798 respectively. The cut-off point of supine ARR was 6.73 (ng/dl)/(ng/L), the diagnostic sensitivity was 79.82% and the specificity was 90.48%. The cut-off point of upright ARR was 4.08 (ng/dl)/(ng/L), the diagnostic sensitivity was 58.77% and the specificity was 87.30%. AUCROC for supine and upright PAC were 0.777 and 0.744 respectively. The cut-off point of supine PAC was 18.15 (ng/dl), the diagnostic sensitivity was 83.33% and the specificity was 64.29%. The cut-off point of upright PAC was 24.39 (ng/dl), the diagnostic sensitivity was 69.30% and the specificity was 74.60%.

  CONCLUSION  Both upright and supine PAC and RAA are valuable for PA diagnosis. The upright and supine ARR have higher specificity but lower sensitivity than PAC.