Intraindividual variability of aldosterone and the aldosterone-to-renin ratio detected by LC-MS/MS and their impact factors in patients with hypertension.

CONTEXT: Previous studies reported that plasma aldosterone concentration (PAC) and aldosterone-to-renin ratio (ARR) exhibit high intraindividual variability among hypertensive patients, but analyses of their variability and impact factors measured by liquid chromatography with tandem mass spectrometry (LC‒MS/MS) and under standard conditions are lacking. DESIGN AND

SETTING

This prospective cohort study was conducted in a tertiary hospital in China. A total of 120 inpatients with hypertension, including 80 patients with primary aldosteronism(PA) and 40 patients with essential hypertension(EH), who underwent PA screening twice on different days were included.

RESULTS

The coefficients of variation (CVs) for PAC and ARR in the PA group were greater than those in the group without PA (PAC: 30.44% vs. 14.30%, P < 0.05; ARR: 54.44% vs. 29.75%, P < 0.05). The proportion of single PAC below the 7.5ng/dl was 41.25% and single ARR below the 15 ng/dL: ng/mL· h was 42.50%. The repeated ARR measurement demonstrated the highest diagnostic accuracy (AUC 0.890), surpassing both the first (AUC 0.856) and second single measurements (AUC 0.812, P < 0.001).

CONCLUSIONS

Under standardized conditions, our study reveals significant intraindividual variability in LC-MS/MS-measured PAC/ARR, associated with PAC levels and PA. We recommend repeated ARR testing for PA detection using LC‒MS/MS to reduce diagnostic omissions.