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Occurrence and Patient Characteristics of Aldosterone Dysregulation in Routine Clinical Care: A Population-Based
Christine Ljungberg1, Uffe Heide-Jørgensen1, Björn Carlsson2
1Aarhus University and Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark.
JACC. Advances
|December 5, 2025
Summary
Aldosterone dysregulation (AD) is four times more common in hypertensive adults than the general population. One in four tested hypertensive adults met the AD threshold, indicating a need for further research into this condition.
Area of Science:
- Endocrinology
- Hypertension Research
- Public Health
Background:
- Current guidelines suggest screening for elevated aldosterone-renin ratio (ARR) in high-risk hypertensive patients.
- The prevalence and characteristics of aldosterone dysregulation (AD) in the general population are not well understood.
Purpose of the Study:
- To investigate the occurrence of AD and its associated clinical characteristics.
- To analyze AD prevalence in both the general and hypertensive populations.
Main Methods:
- A nationwide cohort study utilizing Danish health registries with comprehensive laboratory data.
- Examined annual ARR testing rates and AD occurrence (defined as ARR ≥27.7 pmol/mIU).
- Analyzed clinical characteristics and repeated analyses with stricter ARR thresholds (138.7 and 225.8 pmol/mIU).
Main Results:
- Over 5.42 million adults were included; 18,650 underwent ARR testing (2017-2024).
- AD prevalence in 2023 was 39.1 per 100,000 in hypertensive adults versus 10.0 in the general population.
- Among tested hypertensive adults, 25% met the ARR ≥27.7 pmol/mIU threshold; those with AD had longer hypertension duration and used more antihypertensives.
Conclusions:
- This is the first nationwide study on AD, revealing it is four times more prevalent in hypertensive adults.
- One in four hypertensive adults tested met the primary AD threshold.
- Individuals with AD exhibited higher intensity antihypertensive therapy, suggesting clinical significance.
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