Impact of Age, Sex, and Race on Primary Aldosteronism Test Interpretations
Bibliographic record
Abstract
BACKGROUND: New guidelines recommend testing for primary aldosteronism (PA) in all people with hypertension. Interpreting population-based results for PA will require understanding the influence of demographic characteristics. METHODS: 858 adults from across the US meeting traditional guideline criteria for PA testing underwent testing. The influence of demographic factors on test result interpretations was assessed after multivariable adjustment. RESULTS: Mean age was 62±11 years, with 54.6% women, 14% Black, and 22.9% Hispanic. Independent of antihypertensive medications and clinical comorbidities, participants aged ≥70 years had 24% lower aldosterone ( P <0.05), 48% lower renin activity ( P <0.001), and trended toward higher aldosterone-to-renin ratio (52% higher; P =0.14), compared with those <50 years. Aldosterone levels were higher in women compared with men across the lifespan. Black participants had 81% higher aldosterone-to-renin ratio than White participants ( P <0.001), primarily due to lower renin ( P <0.005). These demographic factors influenced the ultimate PA testing interpretation: participants ≥70 years old had 19% higher odds of a positive test than those <50 years old ( P =0.002), and Black participants had 22% higher odds of a positive test than White participants ( P <0.001). CONCLUSIONS: In this large, diverse, nationwide sample, older and Black participants had higher aldosterone-to-renin ratio and higher odds of testing positive for PA, and women had higher aldosterone levels than men across the lifespan. With newly expanded indications for PA testing, a greater appreciation of the influence of demographic characteristics on PA test results will be required.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".