SAT-282 Renin-Independent Hyperaldosteronism Associated With Increased Risk of Hypertension and Metabolic Syndrome in a Multi-Ethnic Asian Cohort

Abstract Disclosure: X. Luo: None. R. Foo: None. E.S. Saffari: None. J. Ngeow: None. T. Aw: None. D. Hee: None. J. Chambers: None. T. Puar: None. Background: Excess aldosterone activates the mineralocorticoid receptor and causes endothelial dysfunction. This can lead to increased cardiovascular events, insulin resistance, and chronic kidney disease. While hyperaldosteronism has been shown to have adverse implications, it is currently unclear if these effects are seen in both renin-dependent hyperaldosteronism, and renin-independent hyperaldosteronism. Therefore, we aimed to compare the effects of renin-dependent hyperaldosteronism, and renin-independent hyperaldosteronism in a multi-ethnic Asian population on hypertension (HT), metabolic syndrome (MetS), cardiovascular disease (CVD) and chronic kidney disease (CKD). Methods: The Health for Life in Singapore (HELIOS) population study is a large prospective cohort study with participants recruited from the general population from 2017 to 2021. As part of this study, blood was collected from participants at the point of entry. We performed this cross-sectional study by measuring plasma renin activity (PRA) and plasma aldosterone concentration (PAC) in 2000 participants aged 30-84 years. Participants with estimated glomerular filtration rate < 45 ml/min/1.73m2, and those on antihypertensive medications were excluded. Renin-dependent hyperaldosteronism was defined as aldosterone >5 ng/dL with renin >1ng/ml/hr, and renin-independent hyperaldosteronism was defined as aldosterone >5 ng/dL with low renin (PRA≤1ng/ml/h). Multivariable logistic regression was performed adjusting for age, gender, ethnicity, and smoking status. Associations were reported as odds ratios (OR) with 95% confidence intervals (CI). Results: Out of 1395 included participants, 573 (41.1%) were Chinese, 414 (29.7%) Malay, and 408 (29.2%) Indian. The number of participants with HT was 471 (33.8%), MetS 299 (21.6%), type 2 diabetes mellitus 169 (12.1%), CVD 56 (4.0%), and CKD 15 (1.1%). The number of participants with low aldosterone was 472 (33.9%), renin-dependent hyperaldosteronism 444 (31.9%), and renin-independent hyperaldosteronism 476 (34.2%). Compared to those with low aldosterone levels, those with renin-independent hyperaldosteronism was associated with increased risk of HT (OR 1.36 [1.02 - 1.81]) and MetS (OR 1.42 [1.02 - 1.98]), while this was not present in the group with renin-dependent hyperaldosteronism (HT OR 0.987 [0.725 - 1.34], MetS OR 1.33 [0.942 - 1.89]). The proportion of renin-independent hyperaldosteronism was highest amongst Indians 42.6% (95% CI 37.8% - 47.4%), compared to Chinese 34.3% (95% CI 30.4% - 38.2%), and Malays 25.7% (95% CI 21.5% - 29.9%), P<0.001. Conclusion: Renin-independent hyperaldosteronism is associated with higher risk of hypertension and metabolic syndrome, and this was highest amongst Indians, followed by Chinese, compared to the Malays. Evaluation of aldosterone and renin and targeted therapy to ameliorate this risk is necessary. Presentation: Saturday, July 12, 2025