Optimizing Interpretation of Serial Aldosterone-to-Renin Ratio Measurements in Primary Aldosteronism Diagnosis

Highlight

• Serial aldosterone-to-renin ratio (ARR) measurements provide complementary data rather than interchangeable results in diagnosing primary aldosteronism (PA).
• Requiring both ARR measurements to be positive improves balanced diagnostic accuracy, achieving 82.2% sensitivity and 71.9% specificity at a threshold of 49.
• Patients with discordant ARR results represent an intermediate risk group, necessitating nuanced clinical integration and further evaluation.
• Averaging two serial ARR measurements modestly improves discrimination for biochemical confirmation of PA.