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The prevalence of hypertension in Europe is 30% among the adult population, affecting estimated 119 million people in in 2015. Numbers of hypertensive patients are constantly growing and an increase by 15% till 2025 is estimated. Up to 11,9 million people in Europe are referred to be resistant hypertensive. Primary aldosteronism (PA) is a frequent form of resistant hypertension affecting up to 20% of resistant hypertensive patients, up to 2,4 million Europeans.

Design and method:

PA can be can be cured by appropriate second-line drug treatments or surgical procedures, if detected. Recommendations of clinical societies suggest extensive screening efforts to facilitate the early detection of PA among resistant and high-risk hypertensive patients in order to reduce cardiovascular events. However, actual clinical practice does not adhere to these guidelines due to the lack of appropriate screening procedures. A major issue in the diagnostic process of PA is that standard tests interfere with anti-hypertensive therapies, which needs to be discontinued before testing. This imposes a severe cardiovascular risk to affected patients, which is usually not taken by physicians leading to poor adherence to clinical guidelines.


Despite strong limitations regarding selectivity and the interference with multiple anti-hypertensive drugs, the antibody-based determination of the aldosterone-renin-ratio (ARR) is widely used for PA case detection. However, there is still a strong demand for accurate and reliable and patient friendly PA case detection. The Aldosterone-to-Angiotensin-II-Ratio (AA2-Ratio) is a novel LC-MS/MS based high-throughput test for PA that utilizes the plasma levels of aldosterone and physiologically active angiotensin II to generate a diagnostic ratio.


The availability of an innovative diagnostic approach (RAS-Equilibrium-Analysis) paved the way for angiotensin peptides to be used in clinical routine testing by solving pre-analytic problems of analyte stability. The test performance is superior to state-of-the-art tests in terms of the size of the diagnostic window and method accuracy. Importantly, the AA2-Ratio does not interfere with standard anti-hypertensive drugs including ACE inhibitors. First data obtained in a proof-of-concept study proved the AA2-Ratio to be a versatile and powerful diagnostic tool for the diagnosis of PA in hypertension.

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