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Captopril suppression: Limitations for confirmation of primary aldosteronism.

Westerdahl, Christina LU ; Bergenfelz, Anders LU ; Isaksson, Anders LU and Valdemarsson, Stig LU (2011) In Journal of the Renin-Angiotensin-Aldosterone System 12. p.326-332
Abstract
INTRODUCTION: : The aldosterone/renin ratio (ARR) is the first line screening test for primary aldosteronism (PA). However, in hypertensive patients with an increased ARR, PA needs to be confirmed by other means. METHODS: : A 25 mg oral captopril test was performed in 16 healthy subjects to obtain reference values for aldosterone and ARR at 120 minutes after the test. Subsequently these data were applied to 46 hypertensive patients screened for PA with an increased ARR. RESULTS: : At 120 minutes after the captopril test ARR decreased in healthy subjects within a narrow range, but remained high in patients with PA and in patients with primary hypertension, especially for those with low renin characteristics. At 120 minutes after captopril,... (More)
INTRODUCTION: : The aldosterone/renin ratio (ARR) is the first line screening test for primary aldosteronism (PA). However, in hypertensive patients with an increased ARR, PA needs to be confirmed by other means. METHODS: : A 25 mg oral captopril test was performed in 16 healthy subjects to obtain reference values for aldosterone and ARR at 120 minutes after the test. Subsequently these data were applied to 46 hypertensive patients screened for PA with an increased ARR. RESULTS: : At 120 minutes after the captopril test ARR decreased in healthy subjects within a narrow range, but remained high in patients with PA and in patients with primary hypertension, especially for those with low renin characteristics. At 120 minutes after captopril, the range of ARR in primary hypertensive patients overlapped in 88% of the cases with the range of the ARR in the PA patients. Sensitivity and specificity of basal ARR and ARR after the captopril test to diagnose PA, calculated as receiver operator characteristics, showed an area under the curve of 0.595 for basal ARR and 0.664 for ARR at 120 minutes after the test. CONCLUSION: : The ARR at 120 minutes after the captopril test is only marginally better than basal ARR in diagnosing PA in hypertensive patients screened with an increased ARR. Owing to an overall limited capacity to clearly discriminate PA from primary hypertension, the test could not therefore be recommended for the confirmatory diagnosis of PA. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of the Renin-Angiotensin-Aldosterone System
volume
12
pages
326 - 332
publisher
JRAAS Ltd.
external identifiers
  • wos:000294450600025
  • pmid:21273222
  • scopus:80052380853
ISSN
1752-8976
DOI
10.1177/1470320310390405
language
English
LU publication?
yes
id
b0312b9e-51c5-492f-ac66-91beac8a5679 (old id 1777023)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21273222?dopt=Abstract
date added to LUP
2011-02-01 09:28:41
date last changed
2017-08-20 04:38:52
@article{b0312b9e-51c5-492f-ac66-91beac8a5679,
  abstract     = {INTRODUCTION: : The aldosterone/renin ratio (ARR) is the first line screening test for primary aldosteronism (PA). However, in hypertensive patients with an increased ARR, PA needs to be confirmed by other means. METHODS: : A 25 mg oral captopril test was performed in 16 healthy subjects to obtain reference values for aldosterone and ARR at 120 minutes after the test. Subsequently these data were applied to 46 hypertensive patients screened for PA with an increased ARR. RESULTS: : At 120 minutes after the captopril test ARR decreased in healthy subjects within a narrow range, but remained high in patients with PA and in patients with primary hypertension, especially for those with low renin characteristics. At 120 minutes after captopril, the range of ARR in primary hypertensive patients overlapped in 88% of the cases with the range of the ARR in the PA patients. Sensitivity and specificity of basal ARR and ARR after the captopril test to diagnose PA, calculated as receiver operator characteristics, showed an area under the curve of 0.595 for basal ARR and 0.664 for ARR at 120 minutes after the test. CONCLUSION: : The ARR at 120 minutes after the captopril test is only marginally better than basal ARR in diagnosing PA in hypertensive patients screened with an increased ARR. Owing to an overall limited capacity to clearly discriminate PA from primary hypertension, the test could not therefore be recommended for the confirmatory diagnosis of PA.},
  author       = {Westerdahl, Christina and Bergenfelz, Anders and Isaksson, Anders and Valdemarsson, Stig},
  issn         = {1752-8976},
  language     = {eng},
  pages        = {326--332},
  publisher    = {JRAAS Ltd.},
  series       = {Journal of the Renin-Angiotensin-Aldosterone System},
  title        = {Captopril suppression: Limitations for confirmation of primary aldosteronism.},
  url          = {http://dx.doi.org/10.1177/1470320310390405},
  volume       = {12},
  year         = {2011},
}