Higher plasma aldosterone concentrations are associated with left ventricular hypertrophy and geometry in hypertensive patients: a large-scale cross-sectional study

Left ventricular hypertrophy (LVH) represents a critical stage in the prevention of heart failure and existing antihypertensive medications are insufficient to completely resolve LVH induced by hypertension. Plasma aldosterone concentration (PAC) may serve as a potential therapeutic target for the prevention of LVH in hypertension. Previous studies examining the association between PAC and LVH have yielded inconsistent results. The aim of this study was to assess the association of PAC with LVH and left ventricular geometry in hypertensive patients. This cross-sectional study included hypertensive patients admitted to the Hypertension Center at the People’s Hospital of Xinjiang Uygur Autonomous Region from January 1, 2011 to December 31, 2023. Patients with LVH were matched 1:1 with non-LVH patients by age and sex. Logistic regression analyses were performed to evaluate association between PAC with LVH and geometry. The restricted cubic spline (RCS) model evaluated the nonlinear associations between PAC and both LVH and LVMI. Statistical analysis was performed by utilizing R language software, with statistical significance set at p < 0.05. A total of 11,099 LVH patients and 11,099 non-LVH were included. The mean age was 50.94 ± 10.65 years, 56.3% were male, and the mean BMI was 26.71 ± 3.33 kg/m2. Higher PAC (≥14.49 ng/dL) exhibited 1.23-fold higher odds (95% CI 1.16–1.30, p < 0.001) for presence of LVH. An association was identified between PAC and both concentric and eccentric hypertrophies (adjusted OR: 1.02, 95% CI 1.02–1.03, p < 0.001; adjusted OR: 1.02, 95% CI 1.01–1.02, p < 0.001). Stratified analyses revealed a consistent association, with stronger effects observed in males, smoking and alcohol consumption, and serum potassium < 3.5 mmol/L. Sensitivity analyses revealed a robust association between PAC and LVH, concentric, and eccentric hypertrophies, even after excluding primary aldosteronism (PA). Elevated PAC are associated with LVH and both concentric and eccentric hypertrophies in hypertensive patients. Hypertensive patients with PAC levels around 15 ng/dL may require closer monitoring of cardiac remodeling, and elevated PAC levels may serve as a risk marker for LVH.