Role of aldosterone in various target organ damage in patients with hypertensive emergency: A cross-sectional study

Hypertensive emergency is a critical disease that causes multiple organ injuries. Although the renin-angiotensin-aldosterone system (RAS) is enormously activated in this disorder, whether the RAS contributes to the development of the organ damage has not been fully elucidated. This cross-sectional study was conducted to characterize the association between RAS and the organ damage in patients with hypertensive emergencies. We enrolled 54 patients who visited our medical center with acute severe hypertension and multiple organ damage between 2012 and 2020. Upon admission, the hypertensive damage was evaluated, including severe kidney impairment (eGFR less than 30 mL/min/1.73 m 2 , SKI), severe retinopathy, concentric left ventricular hypertrophy (c-LVH), thrombotic microangiopathy (TMA) and heart failure with reduced ejection fraction (HFrEF). Among 54 patients, 30, 34 and 37 cases manifested SKI, severe retinopathy and c-LVH, respectively. Each population with these organ injuries had higher plasma aldosterone concentrations than the remaining subset but exhibited variable difference in systolic or diastolic blood pressure. Twenty-two patients had a triad of SKI, severe retinopathy and c-LVH, among whom 5 patients manifested TMA. Furthermore, the number of the damaged organs was correlated with plasma aldosterone levels (Spearman’s coefficient=0.47), with a strong association between plasma aldosterone (≥250 pg/mL) and 3 or more complications (odds ratio=8.49 [95%CI: 2.37-30.46]). In conclusion, in patients with hypertensive emergencies, a higher aldosterone level not only contributed to the development of the organ damage but also was associated with the number of damaged organs in each patient.