HypertensionCohort study
Renin-Aldosterone Profiles and Cardiorenal Outcomes in Hypertension
- Retrospective cohort study
- registry-based
- linked Danish health registries
Authors' conclusion
Adults with hypertension and renin-independent aldosterone production are at increased risk of rapid kidney function decline as well as, at higher ARR levels, kidney failure and MACE.
Study context
- Population
- Adults with hypertension selected by clinicians for aldosterone and renin testing, Denmark, January 2017 to November 2024
- Participants
- 12,650 adults
- Exposure
- Aldosterone-to-renin ratio (ARR) categories vs lower ARR
- ARR 27.7 to <70 pmol/mIUn = 1,840
- ARR 70 to <138.7 pmol/mIUn = 480
- ARR ≥138.7 pmol/mIUn = 310
- Outcome
- Rapid kidney function decline (eGFR decrease ≥5 mL/min/1.73 m² per year), kidney failure or ≥40% eGFR decline, and MACE
- Follow-up
- Median 3.6 years
Main finding
As reported in the abstract
Rapid kidney function decline
Adjusted hazard ratio (95% CI)
ARR 27.7 to <70 pmol/mIU
1.27(1.17–1.38)
ARR 70 to <138.7 pmol/mIU
1.98(1.75–2.25)
ARR ≥138.7 pmol/mIU
2.66(2.31–3.08)
Observational data: associations, not effects.
Further findings
Kidney failure or ≥40% eGFR decline, and major adverse cardiovascular events (MACE)
- Adjusted HRs (aHRs) not elevated at ARR 27.7-70.0 pmol/mIU, but increased at higher ARR levels
Kidney function decline by aldosterone and renin combinations
- Higher risk with elevated aldosterone in the context of low renin
Original publication
Renin-Aldosterone Profiles and Cardiorenal Outcomes in Hypertension. J Am Coll Cardiol. Published 25 March 2026. doi:10.1016/j.jacc.2026.01.056
Summarised from the published abstract; every number is checked against it