A groundbreaking retrospective analysis of real-world clinical data has revealed that aldosterone dysregulation may pose a significant risk for hypertension at lower thresholds than previously recognized, according to findings presented at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC).
The BREAKTHROUGH Risk study, led by Dr. Raymond Townsend from the University of Pennsylvania School of Medicine, examined data from the TriNetX Dataworks-USA Network, analyzing patients with plasma aldosterone measurements from January 2013 to December 2023. The study identified crucial associations between aldosterone levels and hypertension risk at multiple thresholds.
Key Study Findings
The research team discovered that elevated aldosterone levels, starting at just 5 ng/dL, were significantly associated with hypertension. The adjusted odds ratios for hypertension were:
- 2.01 (95% CI, 1.38–2.92) at ≥5 ng/dL threshold
- 1.81 (95% CI, 1.20–2.72) at ≥10 ng/dL threshold
- 1.89 (95% CI, 1.12–3.17) at ≥15 ng/dL threshold
Study Population and Methodology
The analysis included 1,334 patients with a mean age of 59 years, comprising 55% females and 38% Black participants. Researchers defined hypertension as the first systolic blood pressure measurement ≥130 mmHg during the 12-month follow-up period. The study specifically focused on patients with low renin (≤1 ng/mL/hour) during the baseline period.
Clinical Implications
"This real-world evidence study utilized methods to assess the association between plasma aldosterone and hypertension in clinical practice," explained Dr. Townsend. The findings suggest that aldosterone dysregulation becomes clinically significant at lower levels than the traditional 15 ng/dL threshold, potentially necessitating a reassessment of current screening and treatment protocols.
Type 2 Diabetes Connection
The study also confirmed type 2 diabetes as a significant independent risk factor for hypertension. After adjusting for aldosterone levels, patients with type 2 diabetes showed approximately three times higher odds of developing hypertension compared to those without diabetes (aOR 3.04, 95% CI, 1.73–5.35).
Racial Considerations
Notably, the association between elevated aldosterone levels and hypertension remained significant among White patients after stratification by race, suggesting potential racial differences in the impact of aldosterone dysregulation that warrant further investigation.
These findings highlight the importance of considering aldosterone dysregulation as a key factor in hypertension risk assessment and management, particularly at lower thresholds than previously considered clinically significant. The results may have important implications for early screening and intervention strategies in hypertension management.
