Value of plasma renin activity changes with different posture on identification of primary aldosteronism

doi:10.3877/cma.j.issn.2095-655X.2016.04.011

Abstract

Abstract:

Objective

To evaluate the diagnostic ability of primary aldosteronism(PA) via the changes of plasma renin activity(PRA) with postural variation in hypertensive patients.

Methods

Three hundred and seven patients had received the estimation of PRA, aldosterone level on basal sitting posture and after 2 hours on upright, sitting and supine posture, and collection of other biochemistry measurements.PA group was defined according to aldosterone/renin acrivity ≥554 pmol/L·[μg/ (L·h)]^-1 and plasma aldosterone concentration≥277 pmol/L after saline infusion test, the rest were regarded as no-PA group.Related parameters were calculated to show the sensitivity and specificity, and so on.

Results

In PA group, the levels of PRA upright, sitting, supine [0.61 μg/(L·h), 0.62 μg/(L·h), 0.31 μg/(L·h)] were lower than those of no-PA group[1.42 μg/(L·h), 1.18 μg/(L·h), 0.51 μg/(L·h)], and the differences were statistically significant (F=11.465, 12.052, 10.296; P=0.001). The D-value[0.24 μg/(L·h)] of PRA between PRA upright and PRA supine in PA group was lower than that [0.78 μg/(L·h)] in no-PA group, and the difference was statistically significant (F=8.303, P=0.004). The sensitivity values of PRA upright <1.0 μg/(L·h) or PRA upright-PRA supine<0.6 μg/(L·h) to diagnose PA were 64% and 70%, respectively; the specificity values were 62% and 68%; the negative predictive values were 91% and 93%, respectively.Using PRA upright<1.0 μg/(L·h) and PRA upright-PRA supine <0.6 μg/(L·h) as diagnostic criterion of PA, the sensitivity and specificity values were 45% and 88%, respectively.

Conclusions

There is a low efficacy to use the changes of PRA via posture alteration as a diagnostic standard, but it′s brief and safe to provide some referenced information to doctors on the identification of PA.

Key words: Hypertension, Renin, Aldosterone

Menghui Wang, Nanfang Li, Delian Zhang, Keming Zhou, Qin Luo, Guoliang Wang. Value of plasma renin activity changes with different posture on identification of primary aldosteronism[J]. Chinese Journal of Diagnostics(Electronic Edition), 2016, 04(04): 257-261.

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References 24

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项目	总体(n＝307)	PA组(n＝44)	非PA组(n＝263)	统计量	P值
年龄(岁，±s)	45.5±8.6	47.2±8.2	45.2±8.6	F＝0.695	>0.05
性别(例，男/女)	196/111	25/19	171/92	χ²＝1.095	>0.05
体质量指数(kg/m²，±s)	27.2±3.7	27.7±4.3	27.1±3.5	F＝3.139	>0.05
收缩压(mmHg，±s)	140.2±19.1	140.4±20.2	140.2±19.1	F＝0.003	>0.05
舒张压(mmHg，±s)	94.9±13.2	95.6±13.6	94.7±13.2	F＝0.246	>0.05
血清钾(mmol/L，±s)	3.8±0.4	3.7±0.4	3.9±0.4	F＝5.036	<0.05
血清钠(mmol/L，±s)	141.0±3.0	140.9±2.6	141.0±3.1	F＝0.108	>0.05
坐位PRA[ng/ (mL·h)，±s]	0.9(0.4，2.1)	0.5(0.3，0.6)	1.1(0.5，2.5)	F＝22.399	<0.01
坐位醛固酮(ng/dL，±s)	15.7±7.2	20.3±7.7	14.9±6.8	F＝23.559	<0.01
坐位醛固酮/PRA　(ng/dL·[ng/ (mL·h)]^－1，四分位间距)	14.7(7.3，34.1)	43.4(28.2，78.7)	12.3(6.3，26.9)	χ²＝18.517	<0.01

项目	总体(n＝307)	PA组(n＝44)	非PA组(n＝263)	统计量	P值
年龄(岁，±s)	45.5±8.6	47.2±8.2	45.2±8.6	F＝0.695	>0.05
性别(例，男/女)	196/111	25/19	171/92	χ²＝1.095	>0.05
体质量指数(kg/m²，±s)	27.2±3.7	27.7±4.3	27.1±3.5	F＝3.139	>0.05
收缩压(mmHg，±s)	140.2±19.1	140.4±20.2	140.2±19.1	F＝0.003	>0.05
舒张压(mmHg，±s)	94.9±13.2	95.6±13.6	94.7±13.2	F＝0.246	>0.05
血清钾(mmol/L，±s)	3.8±0.4	3.7±0.4	3.9±0.4	F＝5.036	<0.05
血清钠(mmol/L，±s)	141.0±3.0	140.9±2.6	141.0±3.1	F＝0.108	>0.05
坐位PRA[ng/ (mL·h)，±s]	0.9(0.4，2.1)	0.5(0.3，0.6)	1.1(0.5，2.5)	F＝22.399	<0.01
坐位醛固酮(ng/dL，±s)	15.7±7.2	20.3±7.7	14.9±6.8	F＝23.559	<0.01
坐位醛固酮/PRA　(ng/dL·[ng/ (mL·h)]^－1，四分位间距)	14.7(7.3，34.1)	43.4(28.2，78.7)	12.3(6.3，26.9)	χ²＝18.517	<0.01

组别	例数	立位2 h末	坐位2 h末	卧位2 h末
总体	307	1.23(0.51，2.68)	1.03(0.44，2.23)	0.47(0.25，1.04)
PA组	44	0.61(0.30，1.24)	0.62(0.24，1.17)	0.31(0.19，0.50)
非PA组	263	1.42(0.51，1.42)	1.18(0.50，2.54)	0.51(0.27，1.12)
F值	?	11.465	12.052	10.296
P值	?	0.001	0.001	0.001

组别	例数	立位2 h末	坐位2 h末	卧位2 h末
总体	307	1.23(0.51，2.68)	1.03(0.44，2.23)	0.47(0.25，1.04)
PA组	44	0.61(0.30，1.24)	0.62(0.24，1.17)	0.31(0.19，0.50)
非PA组	263	1.42(0.51，1.42)	1.18(0.50，2.54)	0.51(0.27，1.12)
F值	?	11.465	12.052	10.296
P值	?	0.001	0.001	0.001

组别	例数	PRA_立－PRA_卧	PRA_立－PRA_坐	PRA_坐－PRA_卧
总体	307	0.69(0.21，1.64)	0.17(－0.06，0.52)	0.47(0.17，1.19)
PA组	44	0.24(0.11，0.69)	0.04(－0.08，0.22)	0.23(0.09，0.55)
非PA组	263	0.78(0.26，1.76)	0.18(－0.05，0.57)	0.52(0.19，1.34)
F值	?	8.303	0.895	8.263
P值	?	0.004	0.345	0.004

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