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—In our article, we reported that an aldosterone-PRA ratio of more than 400 is a good criterion for the screening of primary aldosteronism (PA) due to aldosterone-secreting adenoma among hypertensive patients, even when the patient's condition was under control with diuretics. Kho et al have used this criterion while the patient's condition was under control with amiloride therapy and believed that this criterion is useless because of the high incidence of false-positive and false-negative cases. As indicated in our article, we proposed the aforementioned criterion as the screening test but not as the diagnostic tool.
Although we found a small number of false-positive cases, we did not find false-negative cases, even when diuretics were used. Since that time, we have been accumulating data and found six patients with PA and five cases among 358 hypertensive patients. Since additional examinations can be made to establish the final diagnosis and since the
Yamada T. Identifying Aldosterone-Producing Adenoma-Reply. Arch Intern Med. 1982;142(10):1972-1973. doi:10.1001/archinte.1982.00340230222044