title: Reliability of a Bayesian network to predict an elevated aldosterone-to-renin ratio.
abstract: BACKGROUND
  Resistant hypertension is common, mainly idiopathic, but sometimes related to primary aldosteronism. Thus, most hypertension specialists recommend screening for primary aldosteronism.
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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: 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.
authors: Michel
authors: M
authors: Ducher
authors: Vascular medicine and hypertension department, cardiology Hospital, CHRU de Lille, 59000 Lille, France.
authors: Claire
authors: C
authors: Mounier-Véhier
authors: 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.
authors: Pierre
authors: P
authors: Lantelme
authors: Rythmologie et hypertension artérielle, hôpital La Timone, 13385 Marseille, France.
authors: Bernard
authors: B
authors: Vaisse
authors: Department of cardiology, university Hospital, bioclinic radiopharmaceutics laboratory, Inserm U1039, Joseph-Fourier university, 38700 Grenoble, France.
authors: Jean-Philippe
authors: JP
authors: Baguet
authors: 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.
authors: Jean-Pierre
authors: JP
authors: Fauvel
mesh_terms: D000328:Adult; D000450:Aldosterone / Q000097:blood*; D001499:Bayes Theorem; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006973:Hypertension / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012083:Renin / Q000097:blood*; D012084:Renin-Angiotensin System / Q000502:physiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D000450:Aldosterone; D012083:Renin
keywords: Aldosterone-producing adenoma; Aldosterone-to-renin ratio; Aldostérone; Clinical prediction rule; Hypercholestérolémie primaire; Hypertension résistante; Hypokalaemia; Rapport aldostérone/rénine; Resistant hypertension; Règle de prédiction clinique