Association between serum uric acid levels and primary aldosteronism

Primary aldosteronism (PA), the most common cause of secondary hypertension, is associated with increased cardiovascular risks compared to essential hypertension (EH). Although PA is frequently associated with metabolic abnormalities, the role of serum uric acid (SUA) remains unclear. This study aimed to evaluate SUA as a potential biomarker for distinguishing PA from EH.

A retrospective analysis of 152 PA patients and 280 age-matched EH patients hospitalized between January 2019 and February 2024 was conducted. Biochemical and clinical parameters, including SUA, aldosterone-renin ratio (ARR), potassium, and metabolic markers, were analyzed. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses assessed SUA's diagnostic accuracy for PA. Subgroup analyses were conducted by sex and menopausal status. The disease severity of PA patients was further evaluated using the Primary Aldosteronism Severity Classification (PASC).

PA patients exhibited significantly lower SUA levels compared to EH (P < 0.001), independent of age, BMI, and renal function. SUA levels showed a significant inverse correlation with PASC severity grades (Spearman's rho = -0.42, P < 0.001) and no significant difference was observed between APA and IHA subtypes. SUA ≤ 361 µmol/L was strongly associated with PA, with an ROC AUC of 0.750. The ROC curve analysis revealed an AUC of 0.766 for SUA in screening PA among males (optimal cut-off: 364 µmol/L). For premenopausal female patients, the AUC was 0.725 (cut-off: 325 µmol/L), and for postmenopausal females, the AUC was 0.764 (cut-off: 358 µmol/L). The diagnostic performance of SUA surpassed that of the PFK score (AUC: 0.732).

Reduced SUA levels are independently associated with PA, suggesting its potential utility as an auxiliary biomarker to raise suspicion for PA, particularly in settings with limited access to ARR testing. Prospective studies are required to validate its clinical relevance and mechanistic basis.

Not applicable.