High Prevalence of Aldosterone Dysregulation in Hypertensive Adults Tested for Aldosterone and Renin Levels

Presenter: Reimar W Thomsen

This nationwide Danish cohort study (2017–2024) investigated the prevalence of aldosterone dysregulation (AD), defined by elevated aldosterone, suppressed renin, and aldosterone-renin ratio (ARR), using linked laboratory data.

Among 5.3 million adults, 20,596 underwent AD testing, with annual rates of 52–65 per 100,000. In 2023, 19.5% of those tested met AD criteria at ARR ≥27.74 pmol/mIU, decreasing to 3.0% and 1.1% at higher cut-offs. Hypertensive individuals were tested more frequently (157 per 100,000), with 25.4% meeting AD criteria at the lowest ARR threshold. AD prevalence was notably higher in hypertensive adults compared to the general population (36-55 vs.10-16 per 100,000 persons per year) highlighting the need for targeted screening strategies.

Does Urinary Na/K Ratio Predict Future Development of Hypertension in the General Population?

Presenter: Hiroyuki Takase

This longitudinal study assessed whether urinary sodium-to-potassium (Na/K) ratio predicts hypertension onset in the general population.

Among 23,014 adults, cross-sectional analysis showed higher Na/K ratios in males and hypertensive individuals. In 12,483 normotensive participants followed for a median of 1,788 days, 4,056 developed hypertension (58.9 per 1,000 person-years), with incidence rising across Na/K quartiles. The urinary Na/K ratio was significantly associated with blood pressure and hypertension risk (HR=1.028, 95% CI=1.016–1.041), though significance diminished after adjusting for baseline systolic BP. Findings suggest urinary Na/K ratio is a modest but independent predictor of hypertension, partly mediated by baseline BP elevation.

Salt Substitutes and Premature Cardiovascular Deaths in Africa: A Modelling Study

Presenter: Leopold Aminde

This modelling study evaluated the long-term health impact of replacing regular salt with lower sodium potassium-enriched salt substitutes (LSSS) across Africa.

Using a multicohort lifetable model and Global Burden of Disease data, researchers simulated a ten-year government-led LSSS strategy. Results suggest an average 36% reduction in age-standardized hypertension prevalence, with country-specific effects ranging from 22% to 61%. By 2050, LSSS adoption could lower premature cardiovascular deaths by up to 14% in women and 13.9% in men, depending on country. These findings support LSSS as a cost-effective intervention to reduce hypertension and cardiovascular mortality continent-wide.

Ref: ESC Congress 2025, 29^thAug- 1^st Sept 2025, Madrid, Spain