Abstract 4359292: Aldosterone dysregulation is associated with uncontrolled hypertension: Insights from the real-world BREAKTHROUGH Hypertension Study

Background: Association between serum aldosterone levels and uncontrolled hypertension in a real-world diverse population remains understudied. Aim: To evaluate the relationship between systolic blood pressure (SBP) and aldosterone dysregulation among patients with essential hypertension. Methods: Patients with essential hypertension who underwent serum aldosterone measurement between 1/1/2022 and 7/31/2024 were assessed. Patients were divided into cohorts based on SBP ≥130 mmHg (uncontrolled) vs. <130 mmHg and compared according to aldosterone levels, plasma renin activity (PRA), and plasma renin concentration (PRC). Aldosterone dysregulation was defined as aldosterone-to-PRA ratio ≥10 or aldosterone-to-PRC ratio ≥1, and compared with no aldosterone dysregulation group (aldosterone-to-PRA ratio <10 or aldosterone-to-PRC ratio <1), in multivariate logistic regression models adjusted for serum potassium, diabetes, inpatient vs outpatient status, and assay type (immunoassay vs chromatography). Results: Of the 9129 essential hypertension patients, 7169 (79%) had uncontrolled SBP. Compared to patients with controlled SBP, those with uncontrolled SBP were older, and more like to be males and have diabetes. Patients with controlled SBP showed higher baseline PRA (1.6 vs 1 ng/mL/h; p-value<.0001), PRC (13.3 vs 8.9 pg/mL; p-value<.0001), lower aldosterone-to-PRA ratio (4.3 vs 5.7; p-value<.0001) and aldosterone-to-PRC ratio (0.9 vs 1.2; p-value<.0001), compared with patients with SBP ≥130 mmHg. ( Table ) Both patients with controlled and uncontrolled SBP experienced aldosterone dysregulation (31.9% vs 41.5% respectively). Patients with aldosterone dysregulation had increased risk of uncontrolled SBP (OR 1.41 [1.26–1. 56]; p<0.0001) compared to those without aldosterone dysregulation. Stratified analyses by age, sex, race, and potassium status showed similar patterns. Conclusion: In patients with essential hypertension, aldosterone dysregulation was associated with increased risk of uncontrolled hypertension. This association was consistent regardless of demographics and potassium levels.