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VALUE OF PLASMA RENIN ACTIVITY CHANGES WITH DIFFERENT POSTURE ON IDENTIFICATION OF PRIMARY ALDOSTERONISM

Objective: The aim of this study was to evaluate the diagnostic ability of primary aldosteronism (PA) via observing the changes of primary renin activity (PRA) with postural variation in hypertensive patients. Design and method: 307 in-patients have finished the detection 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 on aldosterone/renin acrivity ratio > 20ng/dL [ng/ (mL·h)]-1 and plasma aldosterone concentration > 10ng/dL after saline infusion test, remains were named as no-PA group. Related parameters were calculated to show the sensitivity and specificity, and so on. Results: In PA group, the level of PRA upright, sitting, supine [0.61 (0.30, 1.24)ng/(mL.h), 0.62 (0.24,1.17)ng/(mL.h), 0.31 (0.19,0.50)ng/(mL.h)] was lower than that [1.42 (0.51,1.42)ng/(mL·h), 1.18 (0.50, 2.54) ng/(mL.h), 0.51 (0.27,1.12)ng/(mL.h)] in no-PA group, and the difference was statistically significant [F = 11.465,12.052,10.296, P = 0.001]. The level of PRAupright-PRAsupine [0.24 (0.11,0.69)ng/(mL·h)] in PA group was lower than that [0.78 (0.26,1.76)ng/(mL·h)] in no-PA group, and the difference was statistically significant [F = 8.303, P = 0.004]. The sensitivity of PRA upright < 1.0 ng/(mL·h) or PRA upright-PRA supine < 0.6 ng/(mL·h) to diagnose PA were respectively 64% and 70%; the specificity of that were 62% and 68%; the negative predictive values were 91% and 93%, respectively. Using PRA upright < 1.0 ng/(mL·h) and PRA upright-PRA supine < 0.6 ng/(mL·h) as diagnostic criterion of PA, the sensitivity and specificity are 45% and 88%, respectively. Conclusions: There is a low efficacy using the changes of PRA via posture alteration as a diagnostic standard, but it's brief and safe, it can provide some referenced information to doctors on the identification of PA.