Aldosterone Dysregulation in Essential Hypertension

Aldosterone dysregulation is an important contributor to suboptimal blood pressure control in essential hypertension. A retrospective study was conducted using electronic health record data from Baylor Scott and White Health. Adults ≥ 18 years with essential hypertension who underwent at least 1 measurement of serum aldosterone and plasma renin between January 1, 2022 and October 31, 2024 were included. Aldosterone dysregulation was defined as aldosterone-to-renin ratio (ARR) >10 using plasma renin activity (PRA) or ARR > 1 using plasma renin concentration (PRC). Primary outcomes included uncontrolled hypertension (systolic blood pressure [SBP] ≥130 mmHg) and stage 2 hypertension (SBP ≥ 140 mmHg) based on office SBP obtained closest to and within 1 year following aldosterone measurement. Multivariable logistic regression models were adjusted for diabetes, encounter type, serum potassium, and aldosterone assay type. Among the 9,129 patients (age 58.7 [15.7] years; women 4,720 [51.7%]), aldosterone dysregulation was present in 39.4% patients, and was more prevalent among those with uncontrolled versus controlled hypertension (41.5% vs 31.9%, respectively). Aldosterone dysregulation was associated with uncontrolled hypertension (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.26 to 1.56) and stage 2 hypertension (OR 1.38; 95% CI 1.26 to 1.50) in adjusted analysis. Aldosterone dysregulation was more common in those receiving multiple antihypertensives (44.2% on ≥4 agents, 40.8% on 3, 36.4% on 2, and 33.9% on 1). In conclusion, aldosterone dysregulation is common in patients with essential hypertension and is associated with suboptimal blood pressure control. Currently available treatments may not fully address aldosterone dysregulation.