Key result
Higher screening logARR is linked to ~14% higher major cardiovascular events risk in non-operated primary aldosteronism.
Why the study?
Aldosterone-to-renin ratio and plasma renin activity are measured during screening for primary aldosteronism, but their prognostic relevance after confirmatory classification and subsequent treatment remains uncertain.
Does screening-stage aldosterone-to-renin ratio (ARR) and plasma renin activity (PRA) predict long-term incident major adverse cardiovascular events (MACE) in patients undergoing primary aldosteronism evaluation stratified by confirmatory diagnosis and subsequent adrenalectomy?
Cohort (n=3,178)
Yes
Does screening-stage aldosterone-to-renin ratio (ARR) and plasma renin activity (PRA) predict long-term incident major adverse cardiovascular events (MACE) in patients undergoing primary aldosteronism evaluation stratified by confirmatory diagnosis and subsequent adrenalectomy?
Answers are grounded in this paper and cite their sources.
In patients evaluated for primary aldosteronism, higher screening ARR and lower PRA independently predict long-term cardiovascular events among those with confirmed essential hypertension or medically managed primary aldosteronism, but not among those who undergo adrenalectomy.
Background: Aldosterone-to-renin ratio (ARR) and plasma renin activity (PRA) are measured at the screening stage of primary aldosteronism (PA) evaluation, but their prognostic relevance after confirmatory classification and subsequent treatment remains uncertain. Methods: We linked the seven-hospital Taiwan Primary Aldosteronism Investigation cohort (1991-2023) with nationwide health insurance and mortality data through June 2025. Patients were classified as confirmatory-test-defined essential hypertension (EH), PA without adrenalectomy, or PA with subsequent adrenalectomy. Covariate-adjusted Cox models evaluated screening logARR, logPRA, and logPAC separately in relation to incident major adverse cardiovascular events (MACE; myocardial infarction, stroke, heart failure hospitalization, or cardiovascular death). Results: Among 3,178 participants (EH, 1,433; PA without adrenalectomy, 834; PA with adrenalectomy, 911), 441 (13.9%) experienced MACE during a median 7.9-year follow-up. Adjusted hazard ratios (95% CIs) per 1-unit increase in logARR were 1.09 (1.00-1.19), 1.14 (1.03-1.26), and 0.95 (0.87-1.05), respectively; corresponding logPRA estimates were 0.91 (0.83-0.99), 0.87 (0.79-0.97), and 1.04 (0.93-1.16). LogPAC showed no consistent associations. Primary biomarker-by-phenotype interactions were not significant for logARR (P=0.057) or logPRA (P=0.069); time-varying adrenalectomy analyses were supportive but exploratory. Conclusions: Higher screening ARR and lower PRA were associated with subsequent MACE in confirmatory-test-defined EH and PA without adrenalectomy, but not clearly in PA with subsequent adrenalectomy.
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Pan et al. (2026) conducted a cohort in Hypertension undergoing primary aldosteronism evaluation (n=3,178). Screening log-transformed aldosterone-to-renin ratio (logARR) and plasma renin activity (logPRA) vs. Per 1-unit increase in natural-log-transformed biomarker across clinical phenotypes (EH, PA without adrenalectomy, PA with adrenalectomy) was evaluated on Incident major adverse cardiovascular events (MACE: myocardial infarction, stroke, heart failure hospitalization, or cardiovascular death) associated with screening logARR in PA without adrenalectomy (HR 1.14, 95% CI 1.03-1.26, p=0.013). Higher screening logARR was associated with increased major cardiovascular events in essential hypertension and non-operated primary aldosteronism, but not after adrenalectomy.
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