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Cited by 146Hormonal Regulation and HypertensionRenin-Angiotensin System StudiesAdrenal Hormones and Disorders

Validity of Plasma Aldosterone-to-Renin Activity Ratio in African American and White Subjects With Resistant Hypertension

NISHIZAKA, M, PRATTUBUNAMA, M, ZAMAN, M, COFIELD, S, CALHOUN, D·2005·American Journal of Hypertension
DOI 10.1016/j.amjhyper.2005.01.002
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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 Prior determinations of the validity of the ARR had been generally limited to subjects that could be withdrawn from antihypertensive therapy and to non-African American subjects.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.

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Authors
NISHIZAKA, M., PRATTUBUNAMA, M., ZAMAN, M., COFIELD, S., & CALHOUN, D.
Affiliations
University of Alabama at Birmingham (US)
Corresponding author
NISHIZAKA, M
ORCID
Venue
American Journal of Hypertension
Publisher
Oxford University Press (OUP)
Published
2005-06
Volume
18
Issue
6
Pages
805-812
ISSN
0895-7061 (ISSN-L)
DOI
10.1016/j.amjhyper.2005.01.002
OpenAlex
W1980308464
Cited by
146
References
34
Citations by year
2026: 1 · 2025: 1 · 2024: 5 · 2023: 8 · 2022: 1 · 2021: 3 · 2020: 7 · 2019: 6 · 2018: 9 · 2017: 7 · 2016: 6 · 2015: 9 · 2014: 7 · 2013: 11 · 2012: 12
FWCI
4.97
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Hypertension (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Heart Association
  • National Heart, Lung, and Blood Institute (HL-07457+, HL-075614, R01HL075614, T32HL007457)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
resistant hypertension, primary aldosteronism, plasma renin activity, diagnostic accuracy, screening test, African American patients, racial differences, urinary aldosterone excretion, antihypertensive therapy
MeSH terms
Alabama, Aldosterone, Black or African American, Blood Pressure, Female, Humans, Hyperaldosteronism, Hypertension, Male, Middle Aged, Prospective Studies, Radioimmunoassay, Renin, Risk Factors, Sodium, Reproducibility of Results, Biomarkers, White People

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