Abstract Background Excess aldosterone of 15ng/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 (≥5ng/dL) with the risk of uncontrolled HTN and CKD prevalence. Methods 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 ≤ 1ng/mL/h within 12 months prior, and a systolic blood pressure (SBP) measurement within 12 months following, the index aldosterone measurement. The primary outcome was uncontrolled HTN (SBP ≥130mmHg) prevalence. The secondary outcome was CKD prevalence (CKD diagnosis or eGFR measurement of 60mL/min/1.73m2). The adjusted odds ratio (aOR) of uncontrolled HTN during a 12-month follow-up were calculated among plasma aldosterone groups (≥5 vs 5ng/dL, ≥10 vs 10ng/dL, and ≥15 vs 15ng/dL). Results Patients (N = 1,334) had mean age of 59 years and 55.9% were female. Patients with plasma aldosterone of ≥ 5ng/dL (N = 903) had a higher risk (aOR 95% CI) of uncontrolled HTN (2.01 1.38,2.92; p 0.001) versus 5ng/dL (N = 431). Similar findings were observed for plasma aldosterone levels of ≥ 10ng/dL and ≥15ng/dL. Patients with plasma aldosterone of ≥ 10ng/dL (N = 514) had a higher risk of CKD (1.49 1.15,1.92; p 0.001) versus 10ng/dL (N = 820). Similar findings were observed for plasma aldosterone levels of ≥ 15ng/dL. Conclusions 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.
Townsend et al. (2025) studied this question.