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Subclinical Primary Aldosteronism and Cardiovascular Health: A Population-Based Cohort Study
Gregory L Hundemer1,2, Mohsen Agharazii3, François Madore4
1Department of Medicine, Division of Nephrology, University of Ottawa, Ontario, Canada (G.L.H., M.M.S., S.H., M.R.).
Circulation
|November 30, 2023
Summary
Subclinical primary aldosteronism, indicated by a high aldosterone-to-renin ratio, is linked to poorer cardiovascular health. This includes increased arterial stiffness, cardiac remodeling, and a higher risk of developing hypertension.
Area of Science:
- Endocrinology
- Cardiology
- Hypertension Research
Background:
- Primary aldosteronism is a prevalent cause of hypertension and cardiovascular disease.
- Subclinical forms are common but their cardiovascular impact is not well understood.
Purpose of the Study:
- To investigate the association between subclinical primary aldosteronism and cardiovascular health markers.
- To analyze the relationship between aldosterone-to-renin ratio and arterial stiffness, cardiac remodeling, and incident hypertension.
Main Methods:
- Prospective study of 1284 adults aged 40-69 from the CARTaGENE cohort.
- Assessed aldosterone, renin, and aldosterone-to-renin ratio.
- Measured central blood pressure, pulse wave velocity, cardiac MRI, and incident hypertension.
Main Results:
- Higher aldosterone-to-renin ratio correlated with increased arterial stiffness (central BP, pulse wave velocity).
- Elevated ratio was linked to adverse cardiac remodeling (left atrial volume, LV mass, LV remodeling index).
- Higher odds of left ventricular hypertrophy and incident hypertension were observed.
Conclusions:
- Subclinical primary aldosteronism negatively impacts cardiovascular health.
- Biochemical markers of aldosteronism are associated with arterial stiffness, cardiac remodeling, and hypertension risk.
- Findings are independent of brachial blood pressure.
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