Screening and Diagnosis of Primary Aldosteronism in Patients Using Renin-Angiotensin System Inhibitors - Original Article

Q: Can patients undergoing screening for primary aldosteronism remain on renin-angiotensin system inhibitors?

Yes. The study evaluates PA screening performance while patients are receiving RASIs, without requiring therapy discontinuation.

Q: What pre-washout ARR threshold was reported for diagnosing primary aldosteronism?

The optimal pre-washout ARR cutpoint was 2.69, with sensitivity 83.3% and specificity 87.2%.

Sep 29, 2026

Uploaded by supergirl

This study investigated whether patients receiving renin-angiotensin system inhibitors (RASIs) can undergo reliable screening for primary aldosteronism (PA) without discontinuation of therapy. Consecutive hypertensive patients undergoing PA screening at a single hospital between 2016 and 2024 while on RASIs were recruited. Plasma aldosterone concentration (PAC) and direct renin concentration (DRC) were measured at pre-washout, post-washout, and after captopril-challenge testing, with aldosterone-to-renin ratio (ARR) calculated. Among 412 analyzed patients, PA and essential hypertension showed significant differences in PAC, DRC, and ARR across all time points. Pre-washout ARR (cutpoint 2.69) achieved sensitivity 83.3%, specificity 87.2%, PPV 82.2%, and NPV 88.1%.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Introduction

Background and clinical rationale

Methods and measurements

Patient recruitment and design

Hormone measurements and time points

ROC analysis and diagnostic cutpoints

Results

Differences between PA and essential hypertension

Performance of PAC, DRC, and ARR

The Journal of Clinical Hypertension ORIGINAL ARTICLE Screening and Diagnosis of Primary Aldosteronism in Patients Using Renin-Angiotensin System Inhibitors Qian Wang Hui Dong Hong-Wu Li Yu-Bao Zou Xiong-Jing Jiang Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Correspondence: Yu-Bao Zou ([zouyb1973@sina.com](zouyb1973@sina.com)) Xiong-Jing Jiang (jiangxiongjing103@163.com) Received: 3 July 2025 Revised: 1 November 2025 Accepted: 28 November 2025 Keywords: aldosterone | aldosterone-to-renin ratio | hypertension | primary aldosteronism | renin | secondary ABSTRACT This study investigated whether patients receiving renin-angiotensin system inhibitors (RASIs) can undergo reliable screening for primary aldosteronism (PA) without discontinuation of therapy. Consecutive patients with hypertension who underwent PA screening at our hospital between 2016 and 2024 while on RASIs were recruited. Plasma aldosterone concentration (PAC) and direct renin concentration (DRC) were measured at three time points: pre-washout, post-washout, and post-captopril-challenge test (CCT) . Subsequently, the aldosterone-to-renin ratio (ARR) was calculated, and PAC, DRC, and ARR were compared across time points. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal diagnostic cutpoints. A total of 412 patients on RASIs, with or without calcium-channel blockers (CCBs) or α1-receptor antagonists, were analyzed. Among these, 175 had PA and 237 had essential hypertension (EH). PAC, DRC, and ARR were significantly different between the PA and EH groups across all three time points. Within the PA cohort, PAC (p < 0.001) and ARR (p = 0.016) differed significantly between the pre-washout and post-CCT measurements, whereas DRC did not (p = 0.456). The optimal pre-washout ARR cutpoint of 2.69 demonstrated a sensitivity of 83.3%, specificity of 87.2%, positive predictive value (PPV) of 82.2%, and negative predictive value (NPV) of 88.1% for diagnosing PA. These findings indicate that pre-washout PAC, DRC, and ARR retain high diagnostic performance for PA in patients treated with RASIs, provided that other agents affecting the renin-angiotensin-aldosterone system are not co-administered. 1 Introduction Over recent decades, accumulating evidence has revealed that under conditions of high sodium intake, excessive aldosterone exerts detrimental impacts on the cardiovascular system [1– 3] . These effects operate, at least in part, independently of blood pressure (BP) levels. Individuals diagnosed with primary aldosteronism (PA) face significantly elevated risk of developing cardiovascular, cerebrovascular, and renal complications compared with those with essential hypertension (EH), even when the BP levels and hypertension duration are comparable [4, 5] . The prevalence of PA among patients with hypertension ranges from approximately 5% in primary care settings to 10% in specialized hypertension referral centers [6] . Notably, despite the likelihood of PA exceeding 70% in hypertensive patients with severe hypokalemia, fewer than | Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; ARNI, angiotensin-receptor-neprilysin inhibitor; ARR, aldosterone-to-renin ratio; AUROC, area under the receiver operating characteristic curve; BP, blood pressure; CCB, calcium-channel blocker; CCT, captopril-challenge test; DBP, diastolic blood pressure; DHP-CCB, dihydropyridine calcium-channel blocker; DRC, direct renin concentration; EH, essential hypertension; ESG, Endocrine Society Guidelines; ESH, European Society of Hypertension; MRA, mineralocorticoid receptor antagonist; NDHP-CCB, non-dihydropyridine calcium-channel blocker; PA, primary aldosteronism; PAC, plasma aldosterone concentration; RAAS, re

FAQs

Can patients undergoing screening for primary aldosteronism remain on renin-angiotensin system inhibitors?

Yes. The study evaluates PA screening performance while patients are receiving RASIs, without requiring therapy discontinuation.

Which biomarkers were measured to support PA diagnosis during screening?

Plasma aldosterone concentration (PAC) and direct renin concentration (DRC) were measured, and the aldosterone-to-renin ratio (ARR) was calculated for diagnostic comparison.

What pre-washout ARR threshold was reported for diagnosing primary aldosteronism?

The optimal pre-washout ARR cutpoint was 2.69, with sensitivity 83.3% and specificity 87.2%.

Sep 29, 2026

Uploaded by supergirl