Value of reference ranges of standing renin,aldosterone and angiotensin Ⅱ in reducing the misdiagnosis risk of secondary hypertension
SHAO Bibo
WANG Zhizun
HAO Jianzong
HU Shiang
DAI Yunpu
Abstract：Objective To observe the value of the reference ranges of standing renin,aldosterone and angiotensin Ⅱin reducing the risk of misdiagnosis of secondary hypertension.Methods Clinical data of healthy individuals who underwent physical examinations from November 2022 to December 2024 and met the inclusion criteria were collected.They were divided into 6 groups according to age:18-29 years,30-39 years,40-49 years,50-59 years,60-69 years,and≥70 years.Each group had 120 samples(60 males and 60 females),totaling 720 cases.The levels of standing renin,aldosterone and angiotensinⅡ in healthy individuals were detected by chemiluminescence method.Non-parametric tests were adopted to calculate the percentiles of P2.5 and P97.5 respectively,establish reference ranges for each age group,and analyze the gender differences and age change trends of each index.Another 109 patients with suspected secondary hypertension during the same period were selected.The patients were diagnosed with secondary hypertension according to the established reference ranges of standing renin,aldosterone and angiotensin Ⅱ for each age group,and the results were compared with the confirmed diagnostic results from imaging examinations and other tests.Result In healthy individuals,standing renin,aldosterone,and angiotensin Ⅱall showed a skewed distribution,and the reference range was represented by the bilateral limit values(P2.5-P97.5).There were significant differences in renin among different age groups.The reference ranges were 9.34-111.60 μU/mL for 18-29-year-olds,5.70-95.84 μU/mL for 30-39-year-olds,and 4.77-64.98 μU/mL for 40-59-year-olds respectively.For those aged 60 to 69 years,it was 2.33 to 43.35 μU/mL,and for those aged 70 years and above,it was 3.58 to 58.80 μU/mL.There were significant differences in aldosterone between 18-59-year-olds and those≥60 years old,and the established reference ranges were 9.76-201.70 pg/mL and 21.92-133.95 pg/mL respectively.Angiotensin Ⅱ showed significant differences among the three age groups of 18-59 years,60-69 years,and≥70 years,with reference ranges of 44-101 pg/mL,35-84 pg/mL,and 41-90 pg/mL respectively.The levels of standing renin,aldosterone and angiotensin Ⅱ in the healthy population undergoing physical examination were all negatively correlated with age(P<0.01).There were significant differences in gender with respect to the levels of standing renin,aldosterone and angiotensin Ⅱ in the healthy population undergoing physical examination(P<0.01).The confirmed diagnosis results showed that among the 109 suspected patients,67 cases had secondary hypertension.The number of patients whose standing renin,aldosterone and angiotensin Ⅱ results were consistent with the confirmed diagnostic results was 99,98 and 102,respectively.The diagnostic sensitivity,specificity,accuracy rate,misdiagnosis rate and missed diagnosis rate of standing renin for secondary hypertension were 89.55%,92.86%,90.83%,7.14%and 10.45%,respectively,those of standing aldosterone were 86.57%,95.24%,89.91%,4.76%and 13.43%,respectively,and those of the standing angiotensin Ⅱ were 92.54%,95.24%,93.58%,4.76%,and 7.46%,respectively.Conclusion The reference ranges for standing renin,aldosterone and angiotensin Ⅱ in healthy individuals undergoing physical examinations are inconsistent with those provided in the reagent instructions.Differences in these three indicators were observed between different genders and age groups.The reference range established based on the research results has certain value in reducing the risk of misdiagnosis of secondary hypertension.
Keywords：secondary hypertensionmisdiagnosisreninaldosteroneangiotensin Ⅱdiagnosissensitivityspecificity
Publication Date：2025-10-13
Online Publishing Date：2025-10-21(First online date of this platform, not the publication date of the document)
Pages：8( 18-25 )