Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Sep;16(3):587-98.
doi: 10.1177/1470320313498632. Epub 2014 Jul 16.

The value of losartan suppression test in the confirmatory diagnosis of primary aldosteronism in patients over 50 years old

Chin-Chi Kuo  1 , Poojitha Balakrishnan  2 , Yenh-Chen Hsein  3 , Vin-Cent Wu  4 , Shih-Chieh Jeff Chueh  5 , Yung-Ming Chen  4 , Kwan-Dun Wu  4 , Ming-Jiuh Wang  6 ; TAIPAI group
Collaborators, Affiliations

The value of losartan suppression test in the confirmatory diagnosis of primary aldosteronism in patients over 50 years old

Chin-Chi Kuo et al. J Renin Angiotensin Aldosterone Syst. 2015 Sep.

Abstract

Objective: The diagnosis of primary aldosteronism (PA) among the older-aged population has posed a crucial challenge. Among patients over 50 years old, this trial assessed comparability of the performance of two PA diagnostic tests: losartan and captopril suppression tests.

Methods: A post-hoc subgroup analysis from a prospective cohort was conducted by the TAIPAI (Taiwan Primary Aldosteronism Investigation) group between July 2003 and July 2006. Of the 160 patients in the cohort, 60 patients over 50 years old received captopril and losartan tests to confirm PA.

Results: Among the 60 patients over 50 years old, 31 patients had PA confirmed by standardized protocol. The area under the receiver-operating characteristic (ROC) curve for post-captopril aldosterone was significantly less than that for post-losartan plasma aldosterone concentration (PAC) (0.87 vs 0.94, p=0.02). Using the aldosterone-renin ratio (ARR)>35 with PAC>10 ng/dl, the specificity was 82.76% vs 93.1% and the sensitivity was 77.42% vs 87.10% for the captopril and losartan tests, respectively. The equivalence between the two tests were confirmed by the exact McNemar's test (p=1.0).

Conclusion: The losartan test showed comparable accuracy to confirm PA. Verification of this "elderly-friendly" confirmatory test will be the first step to prepare a specific diagnostic model of PA for the older-aged population.

Keywords: Primary aldosteronism; aldosterone-renin ratio; captopril; hypertension; losartan; plasma aldosterone concentration; plasma renin activity.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study flow diagram. The diagnosis of primary aldosteronism is based on Taiwan Primary Aldosteronism Investigation Group (TAIPAI) protocols. Aldosterone-renin ratio >35 after administration of captopril or losartan indicated a positive result. A plasma aldosterone concentration >10 ng/dl after saline infusion is positive for the test (see text). APA, aldosterone-producing adenoma; EH, essential hypertension; IHA, idiopathic hyperaldosteronism.
Figure 2
Figure 2
Receiver-operating characteristic (ROC) curves for the detection of all primary aldosteronism by (a) post-test PAC, and (b) post-test ARR. PAC, plasma aldosterone concentration; ARR, aldosterone-renin ratio.
Figure 2
Figure 2
Receiver-operating characteristic (ROC) curves for the detection of all primary aldosteronism by (a) post-test PAC, and (b) post-test ARR. PAC, plasma aldosterone concentration; ARR, aldosterone-renin ratio.
Figure 3
Figure 3
The adjusted probability of having PA by using post-captopril and post-losartan ARR at the cut-off value of 35 ng/dl per ng/ml/h. ARR, aldosterone-renin ratio.
Figure 4
Figure 4
The mean PA age at diagnosis and hypertension duration summarized from recent PA studies between January 2000 and July 2012 in five continents. The number in each red bar indicates the mean duration of hypertension.
See this image and copyright information in PMC

References

    1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005 Jan 15-21;365(9455):217–223. - PubMed
    1. Lloyd-Jones DM, Evans JC, Levy D. Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA. 2005 Jul 27;294(4):466–472. - PubMed
    1. Wolf-Maier K, Cooper RS, Banegas JR, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA. 2003 May 14;289(18):2363–2369. - PubMed
    1. Anderson GH, Jr., Blakeman N, Streeten DH. The effect of age on prevalence of secondary forms of hypertension in 4429 consecutively referred patients. J Hypertens. 1994 May;12(5):609–615. - PubMed
    1. Dluhy RG. Uncommon forms of secondary hypertension in older patients. Am J Hypertens. 1998 Mar;11(3 Pt 2):52S–56S. - PubMed

Publication types

LinkOut - more resources