Primary Aldosteronism: Diagnostic Accuracy of the Losartan and Captopril Tests
| العنوان: | Primary Aldosteronism: Diagnostic Accuracy of the Losartan and Captopril Tests |
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| المؤلفون: | Kao-Lang Liu, Bor-Sen Hsieh, Kuo-How Huang, Vin-Cent Wu, H. Chang, Wei-Chou Lin, Shih-Chieh Chueh, Shuo-Meng Wang, Chih-Kang Chiang, Kwan-Dun Wu, Yung-Ming Chen, Shao-Yu Yang, Yen-Hung Lin, Yi-Luwn Ho, Jeng-Wen Huang |
| المصدر: | American Journal of Hypertension. 22:821-827 |
| بيانات النشر: | Oxford University Press (OUP), 2009. |
| سنة النشر: | 2009 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Captopril, Taiwan, Urology, Angiotensin-Converting Enzyme Inhibitors, Losartan, Cohort Studies, Diagnosis, Differential, chemistry.chemical_compound, Primary aldosteronism, McNemar's test, Internal medicine, Hyperaldosteronism, Internal Medicine, medicine, Humans, Prospective Studies, Prospective cohort study, Aldosterone, business.industry, Reproducibility of Results, Middle Aged, medicine.disease, Angiotensin II, Endocrinology, ROC Curve, chemistry, Area Under Curve, ACE inhibitor, Female, Tomography, X-Ray Computed, business, Angiotensin II Type 1 Receptor Blockers, medicine.drug |
| الوصف: | 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 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. |
| تدمد: | 1941-7225 0895-7061 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::783e97e7971ceaeee403ecea10b53770Test https://doi.org/10.1038/ajh.2009.89Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....783e97e7971ceaeee403ecea10b53770 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19417225 08957061 |
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