A primary aldosteronism-like phenotype identified with the aldosterone-to-angiotensin II ratio in black men: the SABPA study

Introduction:Black populations may be more likely to have primary aldosteronism (PA) due to adrenal hyperplasia orother forms of adrenal hyperactivity, with suppressed renin levels and high levels of aldosterone, which may contribute to the development of hypertension.Methods:This sub-study involved 35 black men matched for age, gender and race, and aged 20­65 years, living in the North West Province of South Africa. RAAS triple-A analysis was carried out with LC-MS/MS quantification. Blood pressure, electrocardiography and other variables were deter -mined with known methods.Results:Hypertensive subjects with higher aldosterone levels showed an increased aldosterone­angiotensin II ratio (AA2ratio) compared to the hypertensive subjects with low aldos-terone levels (10.2 vs 3.0 pmol/l;p= 0.003). The serum potassium concentration was significantly lower in the high-aldosterone group and the serum sodium­potassium ratio was significantly higher compared to the low-aldosterone group(3.9 vs 4.5,p= 0.016, 34.8 vs 31.8,p= 0.032, respectively).Furthermore, aldosterone was positively associated with both left ventricular hypertrophy (Cornell product) (SpearmanR=0.560;p= 0.037) and kidney function [albumin-to-creatinineratio (ACR)] (SpearmanR= 0.589,p= 0.021) in the hyper-tensive high-serum aldosterone group Conclusions:The AA2 ratio, a novel screening test that is currently being validated for PA case detection, was used toidentify a PA-like phenotype in black men. Excess aldosterone was associated with endothelial dysfunction and left ventricu-lar hypertrophy, independent of blood pressure