Correlation study of systemic inflammatory response with aldosterone: a comparison between essential hypertension and primary aldosteronism

Objective To observe the levels of peripheral leukocyte-related inflammatory factors in patients with primary aldosteronism (PA) and to explore the correlation between systemic inflammatory response and different serum aldosterone levels. Methods From July 2023 to August 2024, patients admitted to the Cardiology Department of our hospital medical university for hypertension screening were enrolled, including 52 cases of essential hypertension (EH) and 32 cases of confirmed PA. Blood routine tests, IL-6, and hsCRP results were collected upon admission. Differences in inflammatory factor levels between EH and PA patients were compared, as well as differences in leukocyte-related inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammatory index (SII), systemic inflammatory response index (SIRI), interleukin-6 (IL-6), and hypersensitive C-reactive protein (hsCRP) across different aldosterone levels. The correlation between inflammatory factors and aldosterone was analyzed. Results The study ultimately included 52 EH patients and 32 PA patients. The mean age was 55.99 ± 13.98 years, with no significant differences in gender, admission systolic blood pressure, admission diastolic blood pressure, BMI, smoking history, prior diabetes, or prior cardiovascular disease between PA and EH patients. PA patients required more types of antihypertensive medications (P=0.008) and had longer hospital stays (P<0.001). No statistical differences were observed in IL-6, hsCRP, or SII between the two groups. Compared to EH patients, PA patients had lower TC levels (P=0.039), and higher MLR, NLR, SIRI, plasma aldosterone levels (P<0.001), and ARR levels (P<0.001). When grouped by imaging findings, patients with bilateral adrenal hyperplasia or nodules had significantly higher hsCRP levels compared to those with normal adrenal glands or unilateral hyperplasia/nodules. No significant differences were observed in serum IL-6, MLR, NLR, or SIRI levels among the three groups (P>0.05). Pearson correlation analysis and multiple linear regression models showed that MLR and SIRI were significantly and independently correlated with aldosterone levels in all subjects (P<0.05), and this correlation strengthened with increasing aldosterone levels. Conclusion The results indicate that PA patients have higher aldosterone levels compared to EH patients, along with elevated MLR, NLR, and SIRI levels. MLR and SIRI showed a significant positive correlation with aldosterone levels, which strengthened as aldosterone levels increased. Additionally, patients with bilateral adrenal hyperplasia or nodules had significantly higher hsCRP levels, suggesting that inflammation may play an important role in the pathophysiology of PA.