Risk of Hypertension and Chronic Kidney Disease Following Aldosterone Dysregulation

Excess aldosterone of >15 ng/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 (≥5 ng/dL) with the risk of uncontrolled HTN and CKD prevalence.

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 ≤1 ng/mL/h within 12 months before, and a systolic blood pressure (SBP) measurement within 12 months following, the index aldosterone measurement. The primary outcome was uncontrolled HTN (SBP ≥130 mmHg) prevalence. The secondary outcome was CKD prevalence (CKD diagnosis or eGFR measurement of <60 mL/min/1.73 m2). The adjusted odds ratio (aOR) of uncontrolled HTN during a 12-month follow-up was calculated among plasma aldosterone groups (≥5 vs <5 ng/dL, ≥10 vs <10 ng/dL, and ≥15 vs <15 ng/dL).

Patients (N = 1334) had a mean age of 59 years, and 55.9% were female. Patients with plasma aldosterone of ≥5 ng/dL (N = 903) had a higher risk (aOR [95% CI]) of uncontrolled HTN (2.01 [1.38-2.92]; P < .001) versus <5 ng/dL (N = 431). Similar findings were observed for plasma aldosterone levels of ≥10 ng/dL and ≥15 ng/dL. Patients with plasma aldosterone of ≥10 ng/dL (N = 514) had a higher risk of CKD (1.49 [1.15-1.92]; P < .001) versus <10 ng/dL (N = 820). Similar findings were observed for plasma aldosterone levels of ≥15 ng/dL.

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.