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Higher Plasma Aldosterone Linked to 51% Increased CVD Risk in Hypertensive PatientsHigh aldosterone levels raise heart attack and stroke risk in patients with high blood pressure

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Key Takeaway
Consider elevated plasma aldosterone as a potential risk marker for CVD in hypertensive patients, but recognize the association is observational.

This cohort study included 8653 hypertensive patients from a hypertension center and examined the association between plasma aldosterone concentration (PAC) and incident cardiovascular disease (CVD) over a median follow-up of 5.2 years. Patients were grouped by PAC quartiles, with the lowest quartile serving as the reference group.

The primary outcome was incident CVD, which occurred in 737 cases. Compared to the lowest PAC quartile, patients in the highest quartile had a 51% increased risk (HR 1.51; 95% CI 1.23–1.86). The study reports an association, not causation.

Safety and tolerability data were not reported. The study did not report on adverse events, serious adverse events, or discontinuations. Limitations were not explicitly listed, but as an observational study, residual confounding cannot be ruled out.

Clinically, these findings suggest that elevated PAC may be a marker of increased CVD risk in hypertensive patients. However, given the observational design, clinicians should interpret this association cautiously and not assume a causal relationship. Further research is needed to determine if targeting PAC can reduce CVD risk.

For people living with high blood pressure, the heart works overtime every day. A new look at data from 8,653 patients at a hypertension center reveals a hidden danger lurking in their blood. Those with higher levels of aldosterone—a hormone that controls salt and blood pressure—faced a significantly greater chance of developing heart disease. Over a median of 5.2 years, these patients saw a 51% increase in the risk of incident cardiovascular disease compared to those with the lowest levels of this hormone. This finding highlights that aldosterone might not just be a marker of high blood pressure, but a driver of future heart trouble.

The study tracked these patients carefully, finding 737 cases of new heart disease among those with higher hormone levels. The statistical link was strong, with the risk remaining clear even after accounting for other factors. While the study shows an association rather than proving a direct cause, the numbers are too large to ignore. For anyone managing high blood pressure, this suggests that checking aldosterone could be a smart move for early prevention.

It is important to remember that this is an observation from a specific group of patients. The study did not report safety issues or side effects because it focused on natural hormone levels rather than a new drug. However, the message is clear: keeping aldosterone in check might help protect your heart before damage begins.

What this means for you:
High aldosterone levels are linked to a 51% higher risk of heart disease in patients with high blood pressure.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
ObjectiveWhether plasma aldosterone concentration (PAC) is associated with incident cardiovascular disease (CVD) remains unclear in hypertensive patients, particularly after excluding those with primary aldosteronism. This study evaluates the association between PAC and incident CVD.MethodsThis study included hypertensive patients admitted to the hypertension center between January 1, 2014, and December 31, 2017, who had PAC measurements. Incident events encompassed both cardiac events and stroke. Cox proportional hazards models were used to evaluate the association between PAC and the outcome.ResultsA total of 8653 hypertensive patients were included in this study. During a median follow-up of 5.2 years, 737 cases of incident CVD occurred. The incidence of the outcome increased with higher quartiles of PAC. Individuals in the highest quartile of PAC had a 51% increased risk of CVD (HR 1.51, 95% CI 1.23–1.86) compared to those in the lowest quartile. The overall results remained stable and consistent in the stratification and sensitivity analyses.ConclusionsHigher PAC was associated with increased risk of CVD in hypertensive patients, irrespective of concomitant primary aldosteronism. These findings suggest that PAC might be a target for early prevention.
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