Risk of Hypertension and Chronic Kidney Disease following Aldosterone Dysregulation.

Background: Excess aldosterone of > 15ng/dL, in the presence of low renin, is linked to hypertension (HTN) and chronic kidney disease (CKD). This study investigated the association of aldosterone dysregulation at lower plasma aldosterone levels (≥5ng/dL) with the risk of uncontrolled HTN and CKD prevalence.

Methods: Patient plasma aldosterone measurements obtained during 2013-2023 were identified in the TriNetX Dataworks-USA Network of electronic medical records. Eligible patients (≥18 years) had a plasma renin activity measurement of ≤ 1ng/mL/h within 12 months prior, and a systolic blood pressure (SBP) measurement within 12 months following, the index aldosterone measurement. The primary outcome was uncontrolled HTN (SBP ≥130mmHg) prevalence. The secondary outcome was CKD prevalence (CKD diagnosis or eGFR measurement of < 60mL/min/1.73m2). The adjusted odds ratio (aOR) of uncontrolled HTN during a 12-month follow-up were calculated among plasma aldosterone groups (≥5 vs < 5ng/dL, ≥10 vs < 10ng/dL, and ≥15 vs < 15ng/dL).

Results: Patients (N = 1,334) had mean age of 59 years and 55.9% were female. Patients with plasma aldosterone of ≥ 5ng/dL (N = 903) had a higher risk (aOR [95% CI]) of uncontrolled HTN (2.01 [1.38,2.92]; p < 0.001) versus <5ng/dL (N = 431). Similar findings were observed for plasma aldosterone levels of ≥ 10ng/dL and ≥15ng/dL. Patients with plasma aldosterone of ≥ 10ng/dL (N = 514) had a higher risk of CKD (1.49 [1.15,1.92]; p < 0.001) versus <10ng/dL (N = 820). Similar findings were observed for plasma aldosterone levels of ≥ 15ng/dL.

Conclusions: Clinically relevant aldosterone dysregulation, in the presence of low renin, occurs at lower aldosterone levels than previously thought, and remains significantly associated with uncontrolled HTN and CKD prevalence.