Optimizing the aldosterone-to-renin ratio cut-off for screening primary aldosteronism based on cardiovascular risk: a collaborative study.

IF 1.5 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

Clinical and Experimental Hypertension Pub Date : 2024-12-31 Epub Date: 2024-01-25 DOI:10.1080/10641963.2023.2301571

Chunxue He, Ruolin Li, Jun Yang, Hang Shen, Yue Wang, Xiangjun Chen, Wenjin Luo, Qinglian Zeng, Linqiang Ma, Ying Song, Qingfeng Cheng, Zhihong Wang, Fei-Fei Wu, Qifu Li, Shumin Yang, Jinbo Hu

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引用次数: 0

Abstract

Objectives: Aldosterone-to-renin ratio (ARR) based screening is the first step in the diagnosis of primary aldosteronism (PA). However, the guideline-recommended ARR cutoff covers a wide range, from the equivalent of 1.3 to 4.9 ng·dl^-1/mIU∙l^-1. We aimed to optimize the ARR cutoff for PA screening based on the risk of cardiovascular diseases (CVD).

Methods: Longitudinally, we included hypertensive participants from the Framingham Offspring Study (FOS) who attended the sixth examination cycle and followed up until 2014. At baseline (1995-1998), we used circulating concentrations of aldosterone and renin to calculate ARR (unit: ng·dl^-1/mIU∙l^-1) among 1,433 subjects who were free of CVD. We used spline regression to calculate the ARR threshold based on the incident CVD. We used cross-sectional data from the Chongqing Primary Aldosteronism Study (CONPASS) to explore whether the ARR cutoff selected from FOS is applicable to PA screening.

Results: In FOS, CVD risk increased with an increasing ARR until a peak of ARR 1.0, followed by a plateau in CVD risk (hazard ratio 1.49, 95%CI 1.19-1.86). In CONPASS, when compared to essential hypertension with ARR < 1.0, PA with ARR ≥ 1.0 carried a higher CVD risk (odds ratio 2.24, 95%CI 1.41-3.55), while essential hypertension with ARR ≥ 1.0 had an unchanged CVD risk (1.02, 0.62-1.68). Setting ARR cutoff at 2.4 ~ 4.9, 10% ~30% of PA subjects would be unrecognized although they carried a 2.45 ~ 2.58-fold higher CVD risk than essential hypertension.

Conclusions: The CVD risk-based optimal ARR cutoff is 1.0 ng·dl^-1/mIU∙l^-1 for PA screening. The current guideline-recommended ARR cutoff may miss patients with PA and high CVD risk.

Clinical trial registration: ClinicalTrials.gov (NCT03224312).

查看原文本刊更多论文

基于心血管风险优化筛查原发性醛固酮增多症的醛固酮-肾素比值临界值：一项合作研究。

目的：基于醛固酮-肾素比值（ARR）的筛查是诊断原发性醛固酮增多症（PA）的第一步。然而，指南推荐的 ARR 临界值范围很广，从相当于 1.3 到 4.9 ng-dl-1/mIU∙l-1 不等。我们的目的是根据心血管疾病（CVD）风险优化 PA 筛查的 ARR 临界值：我们纵向纳入了弗雷明汉后代研究（Framingham Offspring Study，FOS）中参加第六个检查周期并随访至 2014 年的高血压参与者。在基线期（1995-1998 年），我们使用醛固酮和肾素的循环浓度来计算 1433 名无心血管疾病受试者的 ARR（单位：ng-dl-1/mIU∙l-1）。我们使用样条线回归法计算了基于心血管疾病事件的 ARR 临界值。我们利用重庆原发性醛固酮增多症研究（CONPASS）的横断面数据来探讨从FOS中选择的ARR临界值是否适用于PA筛查：在FOS中，心血管疾病风险随着ARR的增加而增加，直到ARR达到1.0的峰值，随后心血管疾病风险趋于平稳（危险比1.49，95%CI 1.19-1.86）。在 CONPASS 中，与 ARR 为 1.0 的本质性高血压相比，ARR 为 1.0 的本质性高血压的心血管疾病风险更低：基于心血管疾病风险的最佳 ARR 临界值为 1.0 ng-dl-1/mIU∙l-1，可用于 PA 筛查。目前指南推荐的 ARR 临界值可能会漏诊 PA 和心血管疾病高风险患者：临床试验注册：ClinicalTrials.gov (NCT03224312)。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Hypertension 医学-外周血管病

CiteScore

3.90

自引率

0.80%

发文量

审稿时长

6-12 weeks

期刊介绍： Clinical and Experimental Hypertension is a reputable journal that has converted to a full Open Access format starting from Volume 45 in 2023. While previous volumes are still accessible through a Pay to Read model, the journal now provides free and open access to its content. It serves as an international platform for the exchange of up-to-date scientific and clinical information concerning both human and animal hypertension. The journal publishes a wide range of articles, including full research papers, solicited and unsolicited reviews, and commentaries. Through these publications, the journal aims to enhance current understanding and support the timely detection, management, control, and prevention of hypertension-related conditions. One notable aspect of Clinical and Experimental Hypertension is its coverage of special issues that focus on the proceedings of symposia dedicated to hypertension research. This feature allows researchers and clinicians to delve deeper into the latest advancements in this field. The journal is abstracted and indexed in several renowned databases, including Pharmacoeconomics and Outcomes News (Online), Reactions Weekly (Online), CABI, EBSCOhost, Elsevier BV, International Atomic Energy Agency, and the National Library of Medicine, among others. These affiliations ensure that the journal's content receives broad visibility and facilitates its discoverability by professionals and researchers in related disciplines.