Journal Article

Primary Aldosteronism: Diagnostic Accuracy of the Losartan and Captopril Tests

Vin-Cent Wu, Hung-Wei Chang, Kao-Lang Liu, Yen-Hung Lin, Shih-Chieh Chueh, Wei-Chou Lin, Yi-Luwn Ho, Jeng-Wen Huang, Chih-Kang Chiang, Shao-Yu Yang, Yung-Ming Chen, Shuo-Meng Wang, Kuo-How Huang, Bor-Sen Hsieh and Kwan-Dun Wu

in American Journal of Hypertension

Published on behalf of American Journal of Hypertension, Ltd.

Volume 22, issue 8, pages 821-827
Published in print August 2009 | ISSN: 0895-7061
Published online August 2009 | e-ISSN: 1941-7225 | DOI: https://dx.doi.org/10.1038/ajh.2009.89
Primary Aldosteronism: Diagnostic Accuracy of the Losartan and Captopril Tests

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  • Neuroendocrinology and Autonomic Nervous System
  • Biochemistry
  • Endocrinology and Diabetes

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Background

To assess whether angiotensin-II receptor blockers (ARBs) offer any additional advantage in confirming the diagnosis of primary aldosteronism (PA) and their use in the differentiation of PA subtypes.

Methods

A prospective, cohort, head-to-head study was conducted between July 2003 and July 2006. A total of 135 patients received captopril and losartan tests to confirm the diagnosis of PA in the TAIPAI (Taiwan Primary Aldosteronism Investigation) intervention.

Results

In total, 71 patients were diagnosed with PA. The area under the receiver-operating characteristic (ROC) curve of the postcaptopril plasma aldosterone concentration (PAC) was significantly less than that of the postlosartan PAC (0.744 vs. 0.829, P = 0.038). Using an aldosterone–renin ratio (ARR, ng/dl per ng/ml/h) >35 with a PAC >10 ng/dl, the specificity was 89.1% vs. 93.8% and the sensitivity was 66.2% vs. 84.5 % for the captopril test vs. the losartan test, respectively. With respect to the losartan test, the accuracy was 88.9%, the agreement was good (k = 0.778), and there was no disagreement with the McNemar test (P = 0.118). Losartan had the advantage of a better negative predictive value to exclude PA when patients were referred with a serum potassium (SK) level <3.8 mmol/l. When a postlosartan ARR >60 was the cutoff value, the positive predictive value was 82% with a negative predictive value of 57% in distinguishing aldosterone-producing adenomas (APAs) from idiopathic hyperaldosteronism (IHA).

Conclusions

The postlosartan ARR and PAC were shown to have better accuracy for the diagnosis of PA than the captopril test. With a postlosartan ARR >60, APAs can be adequately differentiated from IHA.

American Journal of Hypertension 2009; 22:821–827 © 2009 American Journal of Hypertension, Ltd.

Journal Article.  4904 words.  Illustrated.

Subjects: Neuroendocrinology and Autonomic Nervous System ; Biochemistry ; Endocrinology and Diabetes

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