Michel Ducher1, Claire Mounier-Véhier2, Pierre Lantelme3, Bernard Vaisse4, Jean-Philippe Baguet5, Jean-Pierre Fauvel6. 1. Génomique fonctionnelle de l'hypertension artérielle, EA 4173, université Claude-Bernard Lyon1, 69004 Lyon, France; Hôpital Nord-Ouest, 69655 Villefranche-sur-Saône, France; Department of nephrology-hypertension, hospices civils de Lyon, Lyon, France. 2. Vascular medicine and hypertension department, cardiology Hospital, CHRU de Lille, 59000 Lille, France. 3. Génomique fonctionnelle de l'hypertension artérielle, EA 4173, université Claude-Bernard Lyon1, 69004 Lyon, France; Hôpital Nord-Ouest, 69655 Villefranche-sur-Saône, France; Department of cardiology, hopital de la Coix-Rousse, hospices civils de Lyon, 69004 Lyon, France. 4. Rythmologie et hypertension artérielle, hôpital La Timone, 13385 Marseille, France. 5. Department of cardiology, university Hospital, bioclinic radiopharmaceutics laboratory, Inserm U1039, Joseph-Fourier university, 38700 Grenoble, France. 6. Génomique fonctionnelle de l'hypertension artérielle, EA 4173, université Claude-Bernard Lyon1, 69004 Lyon, France; Hôpital Nord-Ouest, 69655 Villefranche-sur-Saône, France; Department of nephrology-hypertension, hospices civils de Lyon, Lyon, France. Electronic address: jean-pierre.fauvel@chu-lyon.fr.
Abstract
BACKGROUND: Resistant hypertension is common, mainly idiopathic, but sometimes related to primary aldosteronism. Thus, most hypertension specialists recommend screening for primary aldosteronism. AIMS: To optimize the selection of patients whose aldosterone-to-renin ratio (ARR) is elevated from simple clinical and biological characteristics. METHODS: Data from consecutive patients referred between 1 June 2008 and 30 May 2009 were collected retrospectively from five French 'European excellence hypertension centres' institutional registers. Patients were included if they had at least one of: onset of hypertension before age 40 years, resistant hypertension, history of hypokalaemia, efficient treatment by spironolactone, and potassium supplementation. An ARR>32 ng/L and aldosterone>160 ng/L in patients treated without agents altering the renin-angiotensin system was considered as elevated. Bayesian network and stepwise logistic regression were used to predict an elevated ARR. RESULTS: Of 334 patients, 89 were excluded (31 for incomplete data, 32 for taking agents that alter the renin-angiotensin system and 26 for other reasons). Among 245 included patients, 110 had an elevated ARR. Sensitivity reached 100% or 63.3% using Bayesian network or logistic regression, respectively, and specificity reached 89.6% or 67.2%, respectively. The area under the receiver-operating-characteristic curve obtained with the Bayesian network was significantly higher than that obtained by stepwise regression (0.93±0.02 vs. 0.70±0.03; P<0.001). CONCLUSION: In hypertension centres, Bayesian network efficiently detected patients with an elevated ARR. An external validation study is required before use in primary clinical settings.
BACKGROUND: Resistant hypertension is common, mainly idiopathic, but sometimes related to primary aldosteronism. Thus, most hypertension specialists recommend screening for primary aldosteronism. AIMS: To optimize the selection of patients whose aldosterone-to-renin ratio (ARR) is elevated from simple clinical and biological characteristics. METHODS: Data from consecutive patients referred between 1 June 2008 and 30 May 2009 were collected retrospectively from five French 'European excellence hypertension centres' institutional registers. Patients were included if they had at least one of: onset of hypertension before age 40 years, resistant hypertension, history of hypokalaemia, efficient treatment by spironolactone, and potassium supplementation. An ARR>32 ng/L and aldosterone>160 ng/L in patients treated without agents altering the renin-angiotensin system was considered as elevated. Bayesian network and stepwise logistic regression were used to predict an elevated ARR. RESULTS: Of 334 patients, 89 were excluded (31 for incomplete data, 32 for taking agents that alter the renin-angiotensin system and 26 for other reasons). Among 245 included patients, 110 had an elevated ARR. Sensitivity reached 100% or 63.3% using Bayesian network or logistic regression, respectively, and specificity reached 89.6% or 67.2%, respectively. The area under the receiver-operating-characteristic curve obtained with the Bayesian network was significantly higher than that obtained by stepwise regression (0.93±0.02 vs. 0.70±0.03; P<0.001). CONCLUSION: In hypertension centres, Bayesian network efficiently detected patients with an elevated ARR. An external validation study is required before use in primary clinical settings.
Authors: Lingjiao Zhang; Xiruo Ding; Yanyuan Ma; Naveen Muthu; Imran Ajmal; Jason H Moore; Daniel S Herman; Jinbo Chen Journal: J Am Med Inform Assoc Date: 2020-01-01 Impact factor: 4.497
Authors: Monique E A M van Kleef; Frank L J Visseren; Jan Westerink; Michiel L Bots; Peter J Blankestijn; Yolanda van der Graaf; Wilko Spiering Journal: BMC Endocr Disord Date: 2020-04-29 Impact factor: 2.763