{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T02:39:13Z","timestamp":1784774353227,"version":"3.55.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T00:00:00Z","timestamp":1588118400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T00:00:00Z","timestamp":1588118400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Satisfactory tools to preclude low-risk patients from intensive diagnostic testing for primary aldosteronism (PA) are lacking. Therefore, we aimed to develop a decision tool to determine which patients with difficult-to-control hypertension have a low probability of PA, thereby limiting the exposure to invasive testing while at the same time increasing the efficiency of testing in the remaining patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Data from consecutive patients with difficult-to-control hypertension, analysed through a standardized diagnostic protocol between January 2010 and October 2017 (<jats:italic>n<\/jats:italic>\u2009=\u2009824), were included in this cross-sectional study. PA was diagnosed by a combined approach: 1) elevated aldosterone-to-renin ratio (&gt;\u20095.0\u2009pmol\/fmol\/s), confirmed with 2) non-suppressible aldosterone after standardized saline infusion (\u2265280\u2009pmol\/L). Multivariable logistic regression analyses including seven pre-specified clinical variables (age, systolic blood pressure, serum potassium, potassium supplementation, serum sodium, eGFR and HbA1c) was performed. After correction for optimism, test reliability, discriminative performance and test characteristics were determined.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>PA was diagnosed in 40 (4.9%) of 824 patients. Predicted probabilities of PA agreed well with observed frequencies and the c-statistic was 0.77 (95% confidence interval (95%CI) 0.70\u20130.83). Predicted probability cut-off values of 1.0\u20132.5% prevented unnecessary testing in 8\u201332% of the patients with difficult-to-control hypertension, carrying sensitivities of 0.98 (95%CI 0.96\u20130.99) and 0.92 (0.83\u20130.97), and negative predictive values of 0.99 (0.98\u20131.00) and 0.99 (0.97\u20130.99).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>With a decision tool, based on seven easy-to-measure clinical variables, patients with a low probability of PA can be reliably selected and a considerable proportion of patients with difficult-to-control hypertension can be spared intensive diagnostic testing.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12902-020-0528-3","type":"journal-article","created":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T19:03:17Z","timestamp":1588186997000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Development of a clinical decision tool to reduce diagnostic testing for primary aldosteronism in patients with difficult-to-control hypertension"],"prefix":"10.1186","volume":"20","author":[{"given":"Monique E. 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Therefore, it did not require informed consent or ethical approval, which was approved by the institutional ethics committee of the University Medical Center Utrecht (Medisch Ethische Toetsingscommissie Utrecht, reference number: WAG\/mb\/16\/019878).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"M.E.A.M. van Kleef is paid from a research grant by Vascular Dynamics, Inc. to study endovascular baroreflex amplification; F.L.J. Visseren, J. Westerink, M.L. Bots, P.J. Blankestijn and Y. van der Graaf report no conflicts; W. Spiering is a consultant for and has received a research grant from Vascular Dynamics, Inc.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"56"}}