Risk Factors for Primary Aldosteronism in a Hypertensive Population Predicted by Logistic Regression and Decision Tree Models

Wenxiu XU; Te LI; Qifan GUAN; Jihong DUAN

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Wenxiu XU, Te LI, Qifan GUAN, Jihong DUAN. Risk Factors for Primary Aldosteronism in a Hypertensive Population Predicted by Logistic Regression and Decision Tree Models[J]. Journal of Kunming Medical University.

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Wenxiu XU, Te LI, Qifan GUAN, Jihong DUAN. Risk Factors for Primary Aldosteronism in a Hypertensive Population Predicted by Logistic Regression and Decision Tree Models[J]. Journal of Kunming Medical University.

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Risk Factors for Primary Aldosteronism in a Hypertensive Population Predicted by Logistic Regression and Decision Tree Models

Wenxiu XU¹,
Te LI^{1
,
,},
Qifan GUAN¹,
Jihong DUAN^{2
,
,}

1.
Department of Pharmacy，Fuwai Yunnan Hospital，Chinese Academy of Medical Sciences/Affiliated Cardiovascular Hospital of Kunming Medical University，Kunming Yunnan 650102
2.
Department of Pharmacy，Jinghong First People's Hospital，Jinghong Yunnan 666100，China

Received Date: 2025-03-18

Abstract

Abstract

Objective To predict risk factors for primary aldosteronism （PA） in a hypertensive population using Logistic regression and decision tree models. Methods A case group of 118 patients diagnosed with PA and a control group of 113 patients diagnosed with essential hypertension after secondary hypertension screening were enrolled from the Fuwai Cardiovascular Hospital of Yunnan Province between January and November 2024. Logistic regression and decision tree prediction models were established, and the predictive performance of the two models was evaluated using the receiver operating characteristic（ROC）curve. Result The Logistic regression prediction model was: Logit（P） = 2.162 × （comorbid obstructive sleep apnea hypopnea syndrome, OSAHS） − 0.145 × age − 2.140 × serum potassium + 0.429 × plasma aldosterone concentration （recumbent） − 1.591 × direct renin concentration （recumbent） + 0.435 × plasma aldosterone concentration （upright） − 0.150 × direct renin concentration （upright）. Decision tree analysis screened out four risk variables. Factors associated with PA, in order of importance, were: aldosterone-to-renin concentration ratio（ARR）（upright）（P < 0.001）, plasma aldosterone concentration （upright）（P = 0.001）, comorbid OSAHS（P = 0.001）, and plasma aldosterone concentration （recumbent）（P = 0.036）. Conclusion Based on the predictions from both the Logistic regression and decision tree models, comorbid OSAHS, plasma aldosterone concentration （upright）, and plasma aldosterone concentration （recumbent） can be identified as independent risk factors for PA; while age, serum potassium, direct renin concentration （recumbent）, and direct renin concentration （upright））are protective factors. For individuals with comorbid OSAHS and a plasma aldosterone concentration （recumbent） > 10.200 ng/dL, setting the ARR cut-off point at 3.300 ngdL⁻¹/uIUmL⁻¹ may help reduce the clinical missed diagnosis rate of PA.
- Primary aldosteronism,
- Risk factors,
- Logistic regression,
- Decision tree model

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References(22)

References

[1]	Reincke M, Bancos I, Mulatero P, et al. Diagnosis and treatment of primary aldosteronism[J]. Lancet Diabetes Endocrinol, 2021, 9(12): 876-892. doi: 10.1016/S2213-8587(21)00210-2
[2]	Brown J M, Siddiqui M, Calhoun D A, et al. The unrecognized prevalence of primary aldosteronism: A cross-sectional study[J]. Ann Intern Med, 2020, 173(1): 10-20. doi: 10.7326/M20-0065
[3]	Douma S, Petidis K, Doumas M, et al. Prevalence of primary hyperaldosteronism in resistant hypertension: A retrospective observational study[J]. Lancet, 2008, 371(9628): 1921-1926. doi: 10.1016/S0140-6736(08)60834-X
[4]	Parasiliti-Caprino M, Lopez C, Prencipe N, et al. Prevalence of primary aldosteronism and association with cardiovascular complications in patients with resistant and refractory hypertension[J]. J Hypertens, 2020, 38(9): 1841-1848. doi: 10.1097/HJH.0000000000002441
[5]	蒋丹, 刘斌, 付凌云, 等. 环维黄杨星D对醛固酮诱导型心肌肥厚和凋亡的保护作用及机制[J]. 贵州医科大学学报, 2024, 49(2): 169-178. doi: 10.19367/j.cnki.2096-8388.2024.02.002
[6]	Vaidya A, Mulatero P, Baudrand R, et al. The expanding spectrum of primary aldosteronism: Implications for diagnosis, pathogenesis, and treatment[J]. Endocr Rev, 2018, 39(6): 1057-1088.
[7]	Xu Z, Yang J, Hu J, et al. Primary aldosteronism in patients in China with recently detected hypertension[J]. J Am Coll Cardiol, 2020, 75(16): 1913-1922. doi: 10.1016/j.jacc.2020.02.052
[8]	Funder J W, Carey R M, Mantero F, et al. The management of primary aldosteronism: Case detection, diagnosis, and treatment: An endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2016, 101(5): 1889-1916.
[9]	Song Y, Yang S, He W, et al. Confirmatory tests for the diagnosis of primary aldosteronism: A prospective diagnostic accuracy study[J]. Hypertension, 2018, 71(1): 118-124. doi: 10.1161/HYPERTENSIONAHA.117.10197
[10]	Jain A, Baracco R, Kapur G. Pheochromocytoma and paraganglioma-an update on diagnosis, evaluation, and management[J]. Pediatr Nephrol, 2020, 35(4): 581-594.
[11]	孟旭. 原发性醛固酮增多症临床特点、预后与心血管疾病危险因素研究[D]. 北京: 北京协和医学院, 2021.
[12]	Feng Y, Wang J, Shao Z, et al. Predicting related factors of immunological response to hepatitis B vaccine in hemodialysis patients based on integration of decision tree classification and logistic regression[J]. Hum Vaccin Immunother, 2021, 17(9): 3214-3220. doi: 10.1080/21645515.2021.1895603
[13]	刘幸, 李畏娴, 张乐, 等. 基于决策树和logistic回归构建恙虫病合并脓毒症的预测模型[J]. 中国热带医学, 2024, 24(9): 1066-1073. doi: 10.13604/j.cnki.46-1064/r.2024.09.08
[14]	Arnaud C, Bochaton T, Pépin J L, et al. Obstructive sleep apnoea and cardiovascular consequences: Pathophysiological mechanisms[J]. Arch Cardiovasc Dis, 2020, 113(5): 350-358. doi: 10.1016/j.acvd.2020.01.003
[15]	张茹, 赵雅静, 张雯, 等. 高血压患者体力活动时长, 睡眠质量及体重控制对患者报告结局的影响[J]. 昆明医科大学学报, 2025, 46(2): 80-87. doi: 10.12259/j.issn.2095-610X.S20250212
[16]	马若菡, 田茗源, 王波. 原发性醛固酮增多症与阻塞性睡眠呼吸暂停低通气综合征关系的研究进展[J]. 中华高血压杂志, 2022, 30(12): 1147-1151. doi: 10.16439/j.issn.1673-7245.2022.12.012
[17]	Zennaro M C, Boulkroun S, Fernandes-Rosa F L. Pathogenesis and treatment of primary aldosteronism[J]. Nat Rev Endocrinol, 2020, 16(10): 578-589. doi: 10.1038/s41574-020-0382-4
[18]	Burrello J, Monticone S, Losano I, et al. Prevalence of hypokalemia and primary aldosteronism in 5100 patients referred to a tertiary hypertension unit[J]. Hypertension, 2020, 75(4): 1025-1033. doi: 10.1161/HYPERTENSIONAHA.119.14063
[19]	Xu F, Gao Z, Wang G, et al. Prevalence, subtype classification, and outcomes of treatment of primary aldosteronism: A prospective study in China[J]. Endocr Pract, 2021, 27(5): 478-483.
[20]	Younes N, St-Jean M, Desrochers M J, et al. Usefulness of the upright posture test in the diagnosis of primary aldosteronism[J]. J Endocr Soc, 2024, 8(10): bvae155. doi: 10.1210/jendso/bvae155
[21]	中华医学会内分泌学分会. 原发性醛固酮增多症诊断治疗的专家共识(2020版)[J]. 中华内分泌代谢杂志, 2020, 36(9): 727-736. doi: 10.3760/cma.j.cn311282-20241115-00546
[22]	任亚女, 查晓宇, 董作亮. 醛固酮与直接肾素浓度比值筛查天津市高血压人群中原发性醛固酮增多症的最佳切点[J]. 中国慢性病预防与控制, 2024, 32(11): 827-831. doi: 10.16386/j.cjpccd.issn.1004-6194.2024.11.005

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