Screening Renin-Aldosterone Profiles and Long-term Cardiovascular Risk After Primary Aldosteronism Evaluation

Higher screening aldosterone-to-renin ratio (logARR) predicted incident major adverse cardiovascular events in confirmatory-test-defined essential hypertension and PA without adrenalectomy, with adjusted HRs per 1-unit logARR of 1.09 and 1.14.

• Why it matters: Prognostic value of screening aldosterone-to-renin ratio and plasma renin activity after confirmatory classification and treatment is uncertain, limiting risk stratification in primary aldosteronism care.
• What they did: In a linked seven-hospital Taiwan Primary Aldosteronism Investigation cohort (1991–2023; n=3,178) followed for a median 7.9 years, covariate-adjusted Cox models related screening logARR, logPRA, and logPAC to incident MACE.
• The result: Per 1-unit increase in logPRA, adjusted HRs were 0.91 and 0.87 (and 1.04 in PA with adrenalectomy), while logPAC showed no consistent associations; biomarker-by-phenotype interactions were not significant.

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