{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T03:51:46Z","timestamp":1776484306801,"version":"3.51.2"},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Primary aldosteronism (PA) is the commonest secondary cause of hypertension but case\u2010detection remains a challenge. Screening is usually performed in secondary care using an aldosterone:renin ratio (ARR) measurement. Here, we describe the outcomes of screening in primary care, in Oxfordshire, UK.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective observational study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>Adults screened for PA in primary care services in Oxford between 2008 and 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>ARR test results in primary care and outcomes of secondary care evaluation (ARR, saline infusion test, final diagnosis). Primary care and secondary care ARR tests were compared for correlation, concordance and performance in predicting PA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 2915 adults screened in primary care, 455 were referred to secondary care and 107 (3.7% of total population screened) were diagnosed with PA. Primary care ARR showed strong correlation with secondary care ARR (<jats:italic>r<\/jats:italic>\u2009=\u20090.841, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Area under the ROC curve to predict PA was 0.81 (95% CI 0.77\u20130.86) for primary care ARR testing. Primary care ARR cut\u2010off of \u2265\u200930\u2009pmol\/mU showed comparable sensitivity (91.7% vs 92.1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.467) to and modest concordance (Kappa 0.583, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) with secondary care ARR. Use of beta\u2010blockers were associated with higher risk of false positive test result (OR 3.5, 95% CI 1.1\u201312.0, <jats:italic>p<\/jats:italic>\u2009=\u20090.042).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Screening for PA in primary care with ARR is feasible with modest concordance and comparable sensitivity to secondary care testing. Simple referral criteria and raising awareness among primary care colleagues could ensure appropriate referral to secondary care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.15247","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T09:17:56Z","timestamp":1744103876000},"page":"129-136","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Is It Possible to Screen for Primary Aldosteronism Effectively in Primary Care?"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3903-9917","authenticated-orcid":false,"given":"Harsha Anuruddhika","family":"Dissanayake","sequence":"first","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology &amp; Metabolism Churchill Hospital Oxford UK"},{"name":"Department of Clinical Medicine, Faculty of Medicine University of Colombo Colombo Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1897-4682","authenticated-orcid":false,"given":"Bronwen","family":"Warner","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Imperial College London  UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9049-4945","authenticated-orcid":false,"given":"Anne\u2010Marie","family":"Hannon","sequence":"additional","affiliation":[{"name":"Department of Endocrinology University Hospital Limerick Limerick Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7808-5735","authenticated-orcid":false,"given":"Riccardo","family":"Pofi","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology &amp; Metabolism, NIHR Oxford Biomedical Research Centre University of Oxford Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radu","family":"Mihai","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Churchill Cancer Centre Oxford University Hospitals NHS Foundation Trust Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"James","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry Oxford University Hospitals NHS Foundation Trust Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Shine","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry Oxford University Hospitals NHS Foundation Trust Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4739-6773","authenticated-orcid":false,"given":"David William","family":"Ray","sequence":"additional","affiliation":[{"name":"NIHR Oxford Health Biomedical Research Centre, and NIHR Oxford Biomedical Research Centre John Radcliffe Hospital Oxford UK"},{"name":"Oxford Centre for Diabetes, Endocrinology and Metabolism, and Oxford Kavli Centre for Nanoscience Discovery University of Oxford Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3170-8533","authenticated-orcid":false,"given":"Jeremy W.","family":"Tomlinson","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology &amp; Metabolism, NIHR Oxford Biomedical Research Centre University of Oxford Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aparna","family":"Pal","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology &amp; Metabolism Churchill Hospital Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpac079"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-4061"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2016-1472"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.118.11568"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(17)30367-4"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.01.015"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.121.18118"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.119.14359"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.7326\/M20-4873"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2021.0254"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcm.2021.03.005"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja17.00783"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-022-03084-x"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.51438"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1258\/acb.2010.010171"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.plabm.2016.11.002"},{"key":"e_1_2_8_18_1","unstructured":"C.Stock T.Hielscher andA.DiscacciatiDTComPair: Comparison of Binary Diagnostic Tests in a Paired Study Design. 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