Primary Aldosteronism Clinical Trial
Background: The most common pharmacologic test for diagnosis of primary aldosteronism (PA)
is administration of captopril to examine whether abnormal aldosterone to plasma rennin
activity (PRA)(ARR) persists, although active rennin concentration (ARC) in contrast to PRA
may offers advantages with regard to processing and standardization.
Objective: To assess whether post captopril ARC offer any additional advantage in screening
primary aldosteronism (PA) than PRA and establish thresholds for the diagnosis using ARC.
Primary aldosteronism (PA), characterized by an inappropriate production of aldosterone,
affects 5-13% of patients with hypertension(1, 2). The use of aldosterone-renin ratio (ARR)
as screening test contributes to the increased diagnostic rate of this disease(2), but it is
not standardized among laboratories. As the incidence of PA has increased since ARR has been
used as a screening test (3, 4), the difficulty in establishing a diagnosis of PA may be
encountered because of atypical manifestations. Administration of captopril to differentiate
the normal renin-angiotensin- aldosterone axis from autonomous secretion of aldosterone has
been proved to be a safe and effective test in confirmation of the diagnosis (5-8). Several
studies have demonstrated that the ARR after a single dose of captopril is diagnostic (5-8)
and as sensitive as the saline loading test for the identification of aldosterone- producing
adenoma (APA)(8).
Active rennin concentration (ARC) is considerably easier to perform; being a single
immunoradiometric assay as opposed to the initial generation of angiotensin I generated from
angiotensinogen followed by radioimmunoassay of PRA(9). It was demonstrated as a reliable
and convenient screening tool for ambulatory conditions, independent of body posture (10).
Decreased angiotensinogen level is noted in pathological status ( e.g. liver cirrhosis,
sever cardiac failure) (11, 12) that results in dissociate of PRA measurement. PAC when used
in conjunction with aldosterone to produce an ARRARC , has been reported to classify
aldosteronism correctly(13). Although PRA is highly sensitive, the measurement is
time-consuming and measured values can vary considerably between laboratories(14). In
aldosteronism with suppressed renin, the ratio of ARR is clearly dependent on the variants
lower detection limit(15). Though determination of ARC in contrast to PRA offers advantage
with regard to processing and standardization, knowing the postcaptopril sensitivity and
specificity as well as the optimum cut off value of ARC is paramount (16) help to the
diagnosis PA (15, 17, 18) and might serve better performance than ARRPRA.
;
Observational Model: Case Control, Time Perspective: Prospective
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