Published Online
on June 25, 2007

A more recent version of this article appeared on August 1, 2007

This Article Full Text (PDF) Data Supplement All Versions of this Article: 50/2/424    most recent HYPERTENSIONAHA.107.091827v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rossi, G. P. Search for Related Content PubMed PubMed Citation Articles by Rossi, G. P. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB CAPTOPRIL SODIUM CHLORIDE Related Collections Clinical Studies Other hypertension Other diagnostic testing

Submitted on April 3, 2007
Revised on April 21, 2007

Comparison of the Captopril and the Saline Infusion Test for Excluding Aldosterone-Producing Adenoma

Gian Paolo Rossi^*; Anna Belfiore; Giampaolo Bernini; Giovambattista Desideri; Bruno Fabris; Claudio Ferri; Gilberta Giacchetti; Claudio Letizia; Mauro Maccario; Francesca Mallamaci; Massimo Mannelli; Gaetana Palumbo; Damiano Rizzoni; Ermanno Rossi; Enrico Agabiti-Rosei; Achille C. Pessina; Franco Mantero; for the Primary Aldosteronism Prevalence in Italy Study Investigators

From the DMCS Internal Medicine 4 (G.P.R., A.C.P.), Padova, Italy; Internal Medicine (A.B.), Bari, Italy; Internal Medicine (G.B.), Pisa, Italy; Department of Internal Medicine and Public Health (G.D., C.F.), L’Aquila, Italy; Internal Medicine (B.F.), Trieste, Italy; Endocrinology (G.G.), Ancona, Italy; Internal Medicine (C.L.), Rome, Italy; Endocrinology (M. Maccario), Torino, Italy; Nephrology (F.M.), Reggio Calabria, Italy; Endocrinology (M. Mannelli), Firenze, Italy; Internal Medicine (G.P.), Legnano, Italy; Internal Medicine (D.R., E.A.-R.), Brescia, Italy; Azienda Ospedaliera ASMN di Reggio Emilia, Internal Medicine (E.R.), Reggio Emilia, Italy; Endocrinology (F.M.), Padova, Italy.

^* To whom correspondence should be addressed. E-mail: gianpaolo.rossi{at}unipd.it.

Abstract--We performed a prospective head-to-head comparison of the accuracy of the captopril test (CAPT) and the saline infusion test (SAL) for confirming primary aldosteronism due to an aldosterone-producing adenoma (APA) in patients with different sodium intake. A total of 317 (26.9%) of the 1125 patients screened in the Primary Aldosteronism Prevalence in Italy Study underwent both CAPT and SAL. They were composed of the patients with a high aldosterone/renin ratio baseline and 1 every 4 patients without such criterion. The accuracy of post-CAPT or post-SAL plasma aldosterone values for diagnosing APA was estimated with the area under the receiver operator characteristics curves. Primary aldosteronism was found in 120 patients, of which 46 had an APA. No untoward effect occurred with either test. The area under the receiver operator characteristics curve of plasma aldosterone for both tests was higher (P<0.0001) than that under the diagonal, but the between-test difference was borderline significant (P=0.054). The optimal aldosterone cutoff value for identifying APA was 13.9 and 6.75 ng/dL for the CAPT and SAL, respectively. Even at these cutoffs, sensitivity and specificity were moderate because of overlap of values between patients with and without APA. When examined in relation to sodium intake, the accuracy of the SAL surpassed that of the CAPT in the patients with a sodium intake 130 mEq per day; this difference waned at a higher Na⁺ intake. Thus, both the CAPT and the SAL are safe and moderately accurate for excluding APA; at a sodium intake >7.6 g per day, the SAL offers no advantage over the easier-to-perform CAPT.

Key words: secondary hypertension • aldosterone • aldosteronism • clinical science • secondary

This article has been cited by other articles:

				J. W. Funder, R. M. Carey, C. Fardella, C. E. Gomez-Sanchez, F. Mantero, M. Stowasser, W. F. Young Jr., and V. M. Montori Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., September 1, 2008; 93(9): 3266 - 3281. [Abstract] [Full Text] [PDF]

				G. P. Rossi, A. Belfiore, G. Bernini, B. Fabris, G. Caridi, C. Ferri, G. Giacchetti, C. Letizia, M. Maccario, M. Mannelli, et al. Body Mass Index Predicts Plasma Aldosterone Concentrations in Overweight-Obese Primary Hypertensive Patients J. Clin. Endocrinol. Metab., July 1, 2008; 93(7): 2566 - 2571. [Abstract] [Full Text] [PDF]

				G. P. Rossi, M. Bolognesi, D. Rizzoni, T. M. Seccia, A. Piva, E. Porteri, G. A.M. Tiberio, S. M. Giulini, E. Agabiti-Rosei, and A. C. Pessina Vascular Remodeling and Duration of Hypertension Predict Outcome of Adrenalectomy in Primary Aldosteronism Patients Hypertension, May 1, 2008; 51(5): 1366 - 1371. [Abstract] [Full Text] [PDF]

				L. A. Davies, C. Hu, N. A. Guagliardo, N. Sen, X. Chen, E. M. Talley, R. M. Carey, D. A. Bayliss, and P. Q. Barrett TASK channel deletion in mice causes primary hyperaldosteronism PNAS, February 12, 2008; 105(6): 2203 - 2208. [Abstract] [Full Text] [PDF]

				G. P. Rossi, A. C. Pessina, F. Mantero, and for the Primary Aldosteronism Prevalence in Italy More Fuel to the Debate on the "Epidemics of Primary Aldosteronism" Hypertension, January 1, 2008; 51(1): e1 - e2. [Full Text] [PDF]

				N. M. Kaplan Response to More Fuel to the Debate on the "Epidemic of Primary Aldosteronism" Hypertension, January 1, 2008; 51(1): e3 - e3. [Full Text] [PDF]

				N. M. Kaplan and D. A. Calhoun Is There an Unrecognized Epidemic of Primary Aldosteronism? (Con) Hypertension, September 1, 2007; 50(3): 454 - 458. [Full Text] [PDF]