SynthesisHypertension (Dallas, Tex. : 1979)2022
Performance of Confirmatory Tests for Diagnosing Primary Aldosteronism: a Systematic Review and Meta-Analysis.
Synthesis in Hypertension (Dallas, Tex. : 1979), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it, 71 citations in OpenAlex.
- Prevalence of primary aldosteronism in acute stroke or transient ischemic attack: a systematic review and meta-analysis.Frontiers in endocrinology · 2024Pooled it
- Bilateral Adrenal Primary Aldosteronism Is Uniformly Present in Hypertensive Afro-Caribbean First-Generation Immigrants to Western Canada.Journal of the American Heart Association · 2026Article
- Low-renin hypertension in incidental adrenal adenomas and response to aldosterone-targeted therapy: a prospective study.European journal of internal medicine · 2026Article
- Primary aldosteronism.Nature reviews. Disease primers · 2026Review
- Endocrine society 2025 diagnostic criteria increase primary aldosteronism detection in hypertensive patients: a comparative study with 2016 guidelines.International journal of cardiology. Cardiovascular risk and prevention · 2026Article
- Severe Hypokalemia and Life-Threatening Ventricular Arrhythmias: A Case of Normotensive Primary Aldosteronism.Cureus · 2026Article
- Broadening Primary Aldosteronism Screening: Alignment Across Contemporary Guidelines.Hypertension (Dallas, Tex. : 1979) · 2026Review
- Is It Time to Retire Aldosterone Suppression Testing?American journal of hypertension · 2026Review
- Primary Hyperaldosteronism: Epidemiology, Diagnosis, and Clinical Associations.Epidemiologia (Basel, Switzerland) · 2026Review
- Real world experience with [Frontiers in endocrinology · 2026Article
- Screening and Diagnosis Trends for Primary Aldosteronism: A Longitudinal Nationwide Cohort Study of 7.8 Million People.medRxiv : the preprint server for health sciences · 2025Article
- Discordance and shortcomings of aldosterone suppression tests in primary aldosteronism.European journal of endocrinology · 2025Article
- ACE Inhibition to Distinguish Low-Renin Hypertension From Primary Aldosteronism.Hypertension (Dallas, Tex. : 1979) · 2025Article
- Oral Sodium Loading Test Is More Sensitive Than Seated Saline Infusion Test to Confirm Overt Primary Aldosteronism.Journal of the Endocrine Society · 2025Article
- Advances in the biochemical diagnostics of primary aldosteronism: from immunoassays to steroidomics and proteomics.Frontiers in endocrinology · 2025Review
- The Spectrum of Dysregulated Aldosterone Production: An International Human Physiology Study.The Journal of clinical endocrinology and metabolism · 2024Article
- Saline suppression testing-induced hypocalcemia and implications for clinical interpretations.European journal of endocrinology · 2024Article
- Evaluation of aldosterone to direct renin ratio, low renin and related Phenotypes in Afro-Colombian patients with apparent treatment resistant hypertension.Scientific reports · 2024Article
- Challenges in Diagnosing and Managing the Spectrum of Primary Aldosteronism.Journal of the Endocrine Society · 2024Article
- Captopril challenge test: an underutilized test in the diagnosis of primary aldosteronism.Endocrine connections · 2024Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundConfirmatory tests are recommended for diagnosing primary aldosteronism, but the supporting evidence is unclear.
methodsWe searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials. Studies evaluating any guideline-recommended confirmatory test (ie, saline infusion test, salt loading test, fludrocortisone suppression test, and captopril challenge test), compared with a reference standard were included. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the risk of bias. Meta-analyses were conducted using hierarchical summary receiver operating characteristic models.
resultsFifty-five studies were included, comprising 26 studies (3654 participants) for the recumbent saline infusion test, 4 studies (633 participants) for the seated saline infusion test, 2 studies (99 participants) for the salt loading test, 7 studies (386 participants) for the fludrocortisone suppression test, and 25 studies (2585 participants) for the captopril challenge test. Risk of bias was high, affecting more than half of studies, and across all domains. Studies with case-control sampling overestimated accuracy by 7-fold (relative diagnostic odds ratio, 7.26 [95% CI, 2.46-21.43]) and partial verification or use of inconsistent reference standards overestimated accuracy by 5-fold (5.12 [95% CI, 1.48-17.77]). There were large variations in how confirmatory tests were conducted, interpreted, and verified. Under most scenarios, confirmatory testing resulted in an excess of missed cases. The certainty of evidence underlying each test (Grading of Recommendations, Assessment, Development, and Evaluations) was very low.
conclusionsRecommendations for confirmatory testing in patients with abnormal screening tests and high probability features of primary aldosteronism are based on very low-quality evidence and their routine use should be reconsidered.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.