Occurrence and Patient Characteristics of Aldosterone Dysregulation in Routine Clinical Care: A Population-Based Study.

BACKGROUND

Current guidelines recommend screening for elevated aldosterone-renin ratio (ARR) in high-risk hypertensive patients. However, the definition, occurrence, and population-level characteristics of aldosterone dysregulation (AD) remain unclear.

OBJECTIVES

The purpose of this study was to examine the occurrence of AD and associated clinical characteristics.

METHODS

The authors conducted a population-based cohort study using health registries with complete laboratory test results for all Danish residents. The authors examined the annual proportion of ARR testing and AD occurrence, defined as ARR ≥27.7 pmol/mIU (1 ng/dL per mIU/L), in the general and hypertensive population. Clinical characteristics associated with testing and AD were described, and analyses were repeated using different ARR thresholds (138.7 pmol/mIU and 225.8 pmol/mIU).

RESULTS

Among 5.42 million Danish adults, 18,650 underwent ARR testing during 2017-2024. Testing was 4-fold higher in hypertensive adults than in the general population. In 2023, AD prevalence per 100,000 was 39.1 in hypertensive adults compared to 10.0 in the general population. Among tested hypertensive adults, 25.0% met the AD threshold ARR ≥27.7 pmol/mIU, while 4.5% and 1.8% met stricter AD thresholds (138.7 and 225.8 pmol/mIU). Hypertensive adults with AD had longer hypertension duration (7.1 vs 5.2 years) and used more concurrent antihypertensive drugs.

CONCLUSIONS

In this first nationwide study of AD, detected AD was 4 times more prevalent in adults with hypertension compared to the general population. One in 4 hypertensive adults tested met the AD threshold of ARR ≥27.7 pmol/mIU and they had higher intensity of antihypertensive therapy.