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 one measurement of serum aldosterone and plasma renin between January 1, 2022 -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 one year following aldosterone measurement. Multivariable logistic regression models were adjusted for diabetes, encounter type, serum potassium, and aldosterone assay type. Among the 9129 patients (age 58.7 [15.7] years; women 4720 [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] 1.26-1.56) and stage 2 hypertension (OR 1.38; 95% CI 1.26-1.50) 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.