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Association between aldosterone and the risk of cardiovascular disease in hypertensive patients: a cohort study

Lin Gan1, Nanfang Li2, Mulalibieke Heizhati2

  • 1Graduate School, Xinjiang Medical University, Urumqi, China.

Frontiers in Endocrinology
|May 11, 2026
PubMed

Insights

Higher plasma aldosterone concentration (PAC) increases cardiovascular disease (CVD) risk in hypertensive patients, even without primary aldosteronism. This suggests PAC could be a target for early CVD prevention strategies.

Area of Science:

  • Cardiology
  • Endocrinology
  • Hypertension Research

Background:

  • The relationship between plasma aldosterone concentration (PAC) and incident cardiovascular disease (CVD) in hypertensive patients, especially after excluding primary aldosteronism, is not well-established.
  • Hypertension is a major risk factor for CVD, and aldosterone plays a key role in blood pressure regulation.

Purpose of the Study:

  • To investigate the association between plasma aldosterone concentration (PAC) and the risk of incident cardiovascular disease (CVD) in a cohort of hypertensive patients.
  • To determine if elevated PAC is an independent predictor of CVD events in individuals with hypertension.

Main Methods:

  • A cohort study was conducted with 8653 hypertensive patients who had PAC measurements recorded between 2014 and 2017.
  • Incident cardiovascular events (cardiac events and stroke) were tracked over a median follow-up of 5.2 years.
  • Cox proportional hazards models were employed to analyze the association between PAC levels and the risk of developing CVD.

Main Results:

  • During follow-up, 737 cases of incident CVD were recorded.
  • A significant trend of increasing CVD incidence was observed across higher quartiles of PAC.
  • Patients in the highest PAC quartile exhibited a 51% increased risk of CVD compared to those in the lowest quartile (HR 1.51, 95% CI 1.23-1.86).

Conclusions:

  • Elevated plasma aldosterone concentration (PAC) is independently associated with an increased risk of incident cardiovascular disease (CVD) in hypertensive patients.
  • This association persists even in the absence of diagnosed primary aldosteronism, highlighting PAC as a potential risk marker.
  • The findings suggest that PAC may serve as a valuable target for the early prevention of cardiovascular disease in hypertensive individuals.
Abstract

Keywords:
Aldosteronecardiovascular diseasecohort studyhypertensionprimary aldosteronism

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