Comparison on metabolic disorders and uric acid levels between patients with primary aldosteronism and essential hypertension

There is growing evidence that prolonged exposure to high serum aldosterone concentrations results in target organ damage to the heart, kidney, and arterial wall, and that primary aldosteronism (PA) is associated with increased cardiovascular risk. In this study, we aimed to evaluate cardiovascular disease (CVD) risk indicators such as arterial stiffness [with pulse wave velocity (PWV) measurement] in PA patients and endocan levels, which is a biomarker of endothelial dysfunction. 28 patients with PA were included in our study. As the control group, 14 patients with essential hypertension (EHT) and 28 normotensive healthy volunteers were included. Height, weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum fasting glucose, insulin, hemoglobin A1c (HbA1c), C-reactive protein (CRP), lipids and endocan levels of all subjects in the PA, EHT and control groups were measured. PWV measurements were performed to assess arterial stiffness. In the PA group, PWV levels were similar to the EHT group, and endocan levels were lower than the EHT group. In the PA group, PWV levels were higher than the control group, and endocan levels were lower than the control group. When we compared the PA group with new-onset HT with the PA group with long-term HT, PWV levels were higher in the PA group with long-term HT. When we compared the long-term HT group with the EHT group, PWV levels were higher in the long-term HT PA group and endocan levels were higher in the EHT group. When we compared the PA group with long-term HT with the control group, PWV levels were higher in the PA group with long-term HT, and endocan levels were similar in both groups. In our study, it was determined that arterial stiffness increased in PA cases with long-term HT compared to PA cases with new-onset HT, EHT cases and normotensive healthy cases. We found that endocan levels in PA patients were also lower than both EHT patients and healthy controls.

Objective: Primary aldosteronism (PA) is a clinical syndrome characterized by hypokalemia, hypertension, and impaired glucose tolerance. Diabetes in PA is characterized by the impairment of both insulin secretion and sensitivity, but the degree of contribution of these two factors is varied. Therefore, we evaluated insulin sensitivity and secretion in patients with PA using homeostasis model assessment (HOMA) and the insulinogenic index (IGI). Design and Method: We analyzed 32 patients with PA. OGTT was performed before adrenalectomy in all patients, and also after the surgery in a subset of patients. Indices for insulin action, evaluated by HOMA, QUICKI and IGI, were calculated and were compared to those of essential hypertensive (EH) patients. Results: EH group consisted of 21 EH patients. Several parameters, such as age, BMI and blood pressure, were matched between PA and EH groups. Fasting glucose and plasma insulin levels of PA patients were higher than those of EH patients. In addition, PA patients had significantly higher stimulated plasma glucose levels after 120 min and lower plasma insulin levels after 30 min compared to EH patients. Insulin sensitivity was more impaired in patients with PA compared to EH patients, and IGI in PA patients was significantly lower than that of EH patients. On the other hand, HOMA-β was similar between PA and EH patients. Serum potassium correlated inversely with HOMA-IR and positively with QUICKI in PA patients. In 5 PA patients, OGTT was performed after unilateral adrenalectomy. In these patients, serum potassium level was normalized and HOMA-IR was significantly improved after operation. Conclusions: Insulin actions in patients with PA was characterized by insulin resistance associated with hypokalemia in addition to the impairment of early-phase secretory response to glucose. Therapeutic intervention aimed at correcting both potassium and aldosterone levels might improve insulin actions in patients with PA.

To assess the association between polymorphisms of rs3740835(C/A) and rs2604204(A/C) in KCNJ5 gene with the susceptibility to unilateral and bilateral primary aldosteronism (PA). A total of 1043 subjects were studied, which included 83 unilateral PA patients,142 bilateral PA patients and 818 essential hypertensive(EH) patients. The polymorphism of KCNJ5 gene at rs3740835(C/A) and rs2604204(A/C) position were analyzed with a TaqMan genotyping technique. Frequencies of A allele and AA+AC genotype at rs3740835(C/A) in unilateral PA group were significantly higher than EH group (P < 0.05). However, the above frequencies did not show a statistical significance between bilateral PA group and EH group (P > 0.05). No statistical difference was detected in the distribution of alleles or genotypes at rs2604204 (A/C) between unilateral PA and EH group or between bilateral PA and EH group. Haplotypic frequencies of C-A and A-A in unilateral PA group were significantly higher and lower than EH group, respectively. However, there was no statistical difference in the haplotype distribution between bilateral PA and EH groups. Rs3740835(C/A) polymorphism may be associated with unilateral PA but not with bilateral PA. rs2604204(A/C) polymorphism is not associated with either unilateral or bilateral PA. Haplotype C-A and A-A may respectively be susceptibility factor and protective factor for unilateral PA. No haplotype has been found to associate with bilateral PA.

Primary aldosteronism (PA) is one of the most common forms of secondary hypertension. Recent studies suggest that, compared with essential hypertension (EH), PA presents more severe disorders of glycolipid metabolism and organ damages. This case-control retrospective study aimed to ascertain clinical features and metabolic parameters between Chinese patients of PA and EH. 174 PA patients and 174 matched EH patients were recruited. Their clinical features, biochemistry parameters, the ventricular septal thickness, and left ventricular mass index (LVMI) were compared. HOMA-β% and HOMA-IR were calculated to evaluate glucose metabolism. The results showed that there was no significant difference regarding BMI, waist-to-hip ratio, and blood pressure between the two groups. The blood potassium level was significantly lower in PA patients than those in EH patients. The abnormal glucose tolerance and the incidence of diabetes in the PA group were not significantly different from those in EH group, but the insulin secretion levels at 0 min and 30 min were significantly weaker than those in the EH group, and the HOMA-β% was also lower in the PA group than those in the EH group. Left ventricular structural abnormalities in PA patients were more severe than those in EH patients. Subtype analysis indicated that patient with aldosterone-producing adenoma (APA) has more serious hypokalemia and lower levels of HOMA-β% and HOMA-IR comparing to those in the idiopathic adrenal hyperplasia (IHA) patient. These findings demonstrated that PA patients showed more impaired insulin secretion function and more severe left ventricular structural damage compared with EH patients.

Introduction:Primary aldosteronism (PA) is associated with cardiovascular disease and has increased cardiovascular morbidity. Several studies had demonstrated that PA shows more serious myocardial fibrosis compared with essential hypertension (EH) using late Gadolinium-enhanced (LGE) imaging [1, 2]. However, the early myocardial change may not be detected by LGE. Recently, cardiac MRI T1 mapping emerged to be a sensitive technique in detecting early changes of myocardium quantitatively. Our study aimed to demonstrate the early myocardial change in PA patients by applying the T1-mapping technique.Method:81 (male: 25; age: 48±12 years) PA[3] and 44 (male: 21; age: 47±14 years) EH patients diagnosed by the Department of Endocrinology and metabolism according to the 2016 TES guidelines for PA were recruited from September 2018 to May 2019. All the subjects underwent cardiac MRI examinations on a 3T MRI scanner (MAGNETOM Trio a Tim System, Siemens Healthcare, Erlangen, Germany), including steady-state free-precession (SSFP) cine imaging and modified Look-Locker inversion recovery (MOLLI) imaging for T1 mapping. Functional parameters were obtained from cine images by the Argus software (Siemens Healthcare, Erlangen, Germany).The mid-ventricular native T1 value was acquired using the QMass software (Medis, Leiden, The Netherlands). Native T1 value and cardiac function parameters were analyzed between the two groups. Differences of continuous variables were analyzed by Student’s t-test or Mann-Whitney U-test, and the relationships between native T1 value and physiological variables were analyzed by multiple linear regression method.Results:The age (PA: 48±12 years vs EH: 47±14 years; p=0.720) and BMI (PA: 25.06±3.73 vs EH: 25.17±2.83; P=0.874) between two groups had no significant differences. The PA group had a significant higher aldosterone/renin ratio (ARR) than those in the EH group (114.6 (48.7-474.8)ng/dl:ng/ml.h vs 7.6 (4.2-13.8) ng/dl:ng/ml.h; p<0.001). All functional parameters including LVEDVI (PA: 78.66 (72.4-90.6) ml/m2 vs EH: 75.8 (64.3-85.8) ml/m2; p=0.054); LVESVI (PA: 31.7 (26.2-38.4) ml/m2 vs EH: 29.3 (24.9-36.2) ml/m2; p=0.152); LVEF (PA: 59.9 (53.3-65.0)% VS EH: 59.2(55.3-65.6)%; p=0.679); LVmassi (PA: 58.5(47.7-67.7) g/m2 vs EH: 54.9 (47.6-60.1) g/m2; p=0.463) had no differences between the two groups. However, native T1 values were higher in PA group than those in EH group (1227±40ms vs 1203±45ms). The multiple linear regression analysis showed that gender (Beta=-27.678, p<0.001) and PA (Beta=-17.287, p=0.031) were independently related to the native T1 values.Conclusion:PA patients represent more severe and earlier myocardium damage and this might be related to cardiovascular morbidity. The T1-mapping technique in cardiac MRI is more sensitive to evaluate the left ventricular function and to detect the myocardial fibrosis in PA patients.

Primary aldosteronism (PA) is the most common secondary cause of hypertension. The present study investigated differences in left ventricular structure and function between hypertensive patients with PA and sucjects with essential hypertension (EH). One hundred patients with PA and 100 controls with EH were matched for age, gender, and 24-h ambulatory monitoring blood pressure (BP). Left ventricular mass index (LVMI), left atrial volume index (LAVI) and ejection fraction were calculated. LV diastolic function was estimated as the ratio of the early diastolic velocities (E) from transmitral inflow to the early diastolic velocities (e') of tissue Doppler at mitral annulus. PA and EH patients had similar LV dimensions, LV wall thicknesses, LVMI and LV systolic function. PA was associated with greater impairment in diastolic function, as reflected by the lower e' (P=0.004), higher E/e' ratio (P=0.005) and higher LAVI (P=0.02). The LV geometric dimensions and patterns of LV hypertrophy were similar between male patients from the PA and EH groups. However, in female patients, PA was correlated with higher LV internal dimensions (P=0.001), higher LVMI (P=0.04) and lower relative wall thickness (RWT, P=0.001). Multivariate analysis showed that LV diastolic function was independently correlated with age (β=0.416, P<0.001), 24-h systolic BP (β=0.238, P=0.016) and serum potassium (β=-0.201, P=0.036) in PA patients. In conclusion, PA appears to contribute to the impairment of LV diastolic function in both sexes as well as the higher prevalence of eccentric hypertrophy in women than in men compared with EH. Age, 24-h systolic BP and serum potassium levels are independent risk factors for LV diastolic function in PA patients.

To investigate the prevalence of primary aldosteronism (PA) in newly diagnosed diabetic patients with hypertension and to compare clinical differences between newly diagnosed diabetes mellitus with essential hypertension (EH) and PA, and to explore the relationship between plasm aldosterone concentration (PAC) and clinical biochemical variables. A total of 270 newly diagnosed diabetic patients with hypertension were prospectively enrolled in this study. All patients were screened for PA. The positive patients in the screening test were further confirmed by captopril challenge test (CCT) to determine the prevalence of PA. Clinical biochemical indexes were detected. The prevalence of PA in 270 newly diagnosed diabetic patients with hypertension was 18.5%. Compared with patients in the EH group, patients in the PA group had higher systolic blood pressure (SBP), PAC, aldosterone to renin ratio (ARR), and carbondioxide binding force, but lower plasma renin activity (PRA) and serum potassium. Correlation analysis showed that the PAC was positively correlated with homeostasis model assessment-insulin resistance (HOMA-IR) in the EH group (r=0.139, P<0.05), but the correlation was not found in the PA group. Compared with patients with SBP<140 mmHg, patients with SBP≥160 mmHg had the significantly decreased PRA and potassium (P<0.05, P<0.001, respectively), but increased ARR and proportion in the PA patients (P<0.05, P<0.01, respectively). The prevalence of PA is relatively high in newly diagnosed diabetic patients with hypertension. Patients with hypertension above grade 2 should be actively screened for aldosterone. Newly diagnosed diabetic patients with hypertension combined with PA has a higher hypertension compared with the patients without PA.In newly diagnosed diabetic patients with hypertension, PAC may be related to insulin resistance.

Objective To compare the abdominal fat distribution in patients with primary aldosteronism (PA) and essential hypertension (EH), and to analyze the correlation between abdominal fat area and indexes such as glycolipid metabolism and insulin resistance. Methods Forty-five PA and 55 EH patients were collected from inpatients in the First Affiliated Hospital of Zhengzhou University for suspicious secondary hypertension, from September 2016 to February 2019. All patients received quantitative computed tomography to measure the total abdominal fat area (TFA), visceral fat area (VFA), and subcutaneous fat area (SFA) when receiving adrenal CT detection. Visceral obesity was defined as VFA≥130 cm2. The percentage of visceral fat area in total abdominal fat area (V%=VFA/TFA), the ratio of visceral fat area to subcutaneous fat area (V/S=VFA/SFA) and the percentage of visceral obesity were calculated. Results TFA and VFA in EH group were higher than those in PA group matched by age, gender, and body mass index (BMI, all P<0.01), and there were no statistically significant differences in SFA, V%, V/S, and the percentage of visceral obesity between the two groups. In PA group, TFA and VFA were positively correlated with homeostasis model assessment of insulin resistance index (P<0.01), TFA was positively correlated with triglycerides (TG) and low density lipoprotein-cholesterol, while SFA was positively correlated with TG (all P<0.05). Conclusion Compared with EH patients matched by age, gender, and BMI, TFA and VFA in PA patients are lower. Abdominal fat area is associated with insulin resistance and blood lipids in PA patients, while VFA exerts a greater effect on insulin resistance than that of TFA and SFA. Key words: Primary aldosteronism; Abdominal fat area; Insulin resistance; Quantitative computed tomography

Objective: To evaluate the value of captopril challenge test (CCT) in the diagnosis of primary aldosteronism (PA). Methods: A total of 674 patients [(45.0±13.7) years, men 341, women 333] admitted to Peking Union Medical College Hospital from 2000 to 2015 were analyzed. Among them, 222 subjects were with essential hypertension (EH), 28 were with pheochromocytoma (PHEO), 246 were with idiopathic hyperaldosteronism (IHA) and 178 were with aldosterone producing adenoma (APA). All patients received CCT. 24 h urine sodium was measured in partial patients. Plasma renin activity (PRA), aldosterone (ALD) were detected. Results: Compared with EH [PRA: before 0.5(0.2, 0.9) μg·L(-1)·h(-1,) after 0.8(0.4, 1.5) μg·L(-1)·h(-1;) ALD: before (393±122) pmol/L, after (360±97) pmol/L] and PHEO [PRA: before 0.3(0.1, 0.9) μg·L(-1)·h(-1,) after 0.4(0.1, 1.6) μg·L(-1)·h(-1;) ALD: before (396±108) pmol/L, after (374±114) pmol/L], lower levels of PRA and higher levels of ALD before and after CCT were observed in PA patients [PRA: before 0.1 (0.1, 0.2) μg·L(-1)·h(-1,) after 0.1 (0.1, 0.2) μg·L(-1)·h(-1;) ALD: before (468±216) pmol/L; after (457±199) pmol/L]. After CCT, the suppression rate of ALD [2.8% (-8.8%, 15.4%) vs 6.6% (-4.3%, 17.6%)] and increasing rate of PRA [0(0, 50%) vs 50%(0, 200%)] in PA patients were lower than those in EH patients. The ALD/PRA ratio (ARR) were higher in PA than that in EH or PHEO patients. In the EH subjects, ALD levels of seated posture were higher than those of recumbent posture both before and after receiving captopril, but with no changes in ARR after CCT. No significant differences in ALD and ARR (before and after receiving captopril) were observed between seated and recumbent position in the PA group. The ARR after CCT tended to decrease in EH subjects with elevated urine-sodium compared with those with normal urine-sodium. No changes could be viewed in ALD and PRA levels between normal urine-sodium and elevated urine-sodium groups among APA, IHA and EH patients either before or after CCT. Among patients with APA, the ALD levels before CCT and the ARR after CCT were lower in the patients with AngiotensionⅡ(AngⅡ) reactive than those without. A ROC curve analysis suggested that the optimal cutoff value was 46.2 (ALD unit: ng/dl; PRA unit: μg·L(-1)·h(-1)) for ARR after challenge in diagnosing PA, with the sensitivity of 88.7% and specificity of 84.8%. Conclusions: ARR after 25 mg captopril had high sensitivity and specificity in diagnosis of PA with the cutoff of 46.2. Seated CCT could replace recumbent CCT as a more confirmatory test. The PRA increasing rate should be taken into consideration when diagnosis of PA.

Introduction. Brain natriuretic peptide (BNP) has important role in the diagnosis and management of heart failure. Data on the impact of blood pressure (BP) on BNP are controversial. In primary aldosteronism (PA), BNP production can be affected by both hypertension and specific endocrine mechanisms. This study was aimed at investigating the impact of hypertension and hyperaldosteronism on plasma BNP levels. Methods. Plasma BNP concentration, casual and 24‐h BP and echocardiographic indices were assessed in 40 patients with moderate to severe essential hypertension (EH), 40 BP‐matched patients with PA, and 40 age‐ and sex‐matched healthy controls. Results. BNP levels in PA and EH groups did not differ significantly and were higher compared with those in controls [median and interquartile range 26 (13–48) pg/ml, p = 0.01, and 23 (9–32) pg/ml, n.s., vs 14 (6–26) pg/ml in controls]. Remarkably elevated BNP was observed only in three PA and two EH patients, all having significant left ventricular (LV) hypertrophy. BNP levels in PA and EH groups correlated weakly with casual and 24‐h BP, interventricular septal thickness and LV mass index (LVMI). Diastolic BP and LVMI were identified as the strongest independent determinants of BNP (p = 0.002 and p = 0.01, respectively). Conclusions. Both PA and EH patients had modest and mutually comparable elevation of BNP, which was independently determined by diastolic BP and LVMI. Both subtypes of PA (aldosterone‐producing adenoma and bilateral adrenal hyperplasia) had similar effect on BNP production. Specific impact of hyperaldosteronism on BNP was not confirmed.

Case-control observational study to evaluate the microvascular and macrovascular changes in patients with hypertension secondary to primary aldosteronism (PA), essential hypertension (EH) and healthy subjects. Measurements of arterial stiffness including augmentation index (AIx) and pulse wave velocity (PWV) were assessed using a TensioClinic arteriograph system. Retinal microcirculation was imaged by a Retinal Vessel Analyzer (RVA) and a non-midriatic camera (Topcon-TRC-NV2000). IMEDOS software analyzed the retinal artery diameter (RAD), retinal vein diameters (RVD) and arteriole-to-venule ratio (AVR) of the vessels coming off the optic disc. Thirty, 39 and 35 patients were included in the PA, EH and control group, respectively. The PA group showed higher PWV values compared only with the control group. The mean brachial and aortic AIx values did not show significant difference between groups. In the PA group, the mean RVD and AVR values were significantly lower than in the EH and control groups, whereas the parameters did not differ between the EH and control groups. In conclusion, AVR appears significantly modified in the PA group compared with the EH group and could represent an early and more reliable indicator of microvascular remodeling.

Uric acid (UA) is considered to be one of the most important antioxidants in the blood. While high UA levels are found in many disease states, low UA levels are reported in many neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, multiple sclerosis, and amyotrophic lateral sclerosis (ALS). Various studies showed consistently that ALS patients have lower serum UA levels than healthy individuals, more prominently in cases with bulbar onset and longer disease duration. A systematic search of PubMed was conducted to retrieve published studies on UA levels in ALS patients. A meta-analysis was performed on published studies comparing UA levels between ALS patients and controls. This meta-analysis revealed highly statistically significant (p < 0.0001) lower UA levels and a very large size effect in 311 ALS patients compared to 515 controls as a group, as well as calculated for men and women separately. Many studies indicate that patients with neurodegenerative diseases, including ALS, have low UA levels. Our meta-analysis strengthens these findings in ALS patients, demonstrating highly statistically significant (p < 0.0001) lower UA levels in patients compared to controls, with very large total size effect, more prominent in men.

Aim:This study aimed to evaluate whether the increased cardiovascular risk and the incidence of cerebrovascular (CCV) events in hypertensive patients were related to primary aldosteronism (PA).Methods:The PubMed, EmBase, and the Cochrane Central Register of Controlled Trials were searched to evaluate the risk of CCV in PA patients and compared to essential hypertension (EH) patients. The mean differences (MD) and the risk ratios (RR) were calculated to assess the risk of main outcomes, such as stroke, coronary artery disease, left ventricular hypertrophy (LVH), levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose, and urinary potassium.Results:We identified 31 individual studies including 4546 patients in PA group and 52,284 patients in EH group. Our results revealed that PA was significantly associated with increased risk of stroke (RR=2.03, 95% CI = 1.71–2.39, Pheterogeneity = .331, I2 = 12.7%), coronary artery disease (RR = 1.67, 95% CI = 1.23–2.25, Pheterogeneity = .043, I2 = 48.3%), and LVH (RR = 1.54, 95% CI = 1.29–1.83, Pheterogeneity = .004, I2 = 62.6%) when compared with those in the EH group. Moreover, PA group had significantly increased levels of SBP (WMD = 4.14, 95% CI = 2.60–5.68, Pheterogeneity < .001, I2 = 84.3%), DBP (WMD = 2.65, 95% CI = 1.83–3.47, Pheterogeneity < .001, I2 = 77.7%), and urinary potassium (SMD = 0.04, 95% CI = -0.03–0.11, Pheterogeneity = .827, I2 = 0%) when compared to EH group. However, no significant difference was observed in the levels of blood glucose between the groups.Conclusions:These findings suggested that PA significantly increased the risk of cardiac and cerebrovascular complications. In addition, patients with PA might benefit from a periodic assessment of CCV risk.

To investigate the associations of plasma aldosterone concentration (PAC), plasma renin activity (PRA), and aldosterone-to-renin ratio (ARR) with Gompertz law-based biological age difference (GOLD BioAgeDiff) in patients with primary aldosteronism versus essential hypertension (EHT), and to determine whether GOLD BioAgeDiff relates to cardiac mass. We conducted a retrospective cross-sectional study of 1201 hypertensive adults (785 with primary aldosteronism and 416 with EHT). GOLD BioAgeDiff was defined as the calculated biological age minus chronological age. Multivariable linear regression was used to evaluate the associations of PAC, PRA, and ARR with GOLD BioAgeDiff. Furthermore, we assessed the relationship between GOLD BioAgeDiff and echocardiographic indices, including left ventricular mass index (LVMI) and excessive LVMI (eLVMI). Primary aldosteronism patients demonstrated significantly higher GOLD BioAgeDiff than EHT patients. In fully adjusted models, ARR was positively associated with GOLD BioAgeDiff in the primary aldosteronism group ( β = 0.292, P = 0.008) but not in the EHT group ( P for interaction = 0.032). PAC and postcaptopril PAC were also positively associated with GOLD BioAgeDiff in primary aldosteronism. Furthermore, higher GOLD BioAgeDiff was associated with greater eLVMI ( β = 0.591, P < 0.001) and LVMI ( β = 0.640, P = 0.001) in primary aldosteronism patients, suggesting a potential mediating role in the relationship between ARR and cardiac remodeling. Among patients with primary aldosteronism, elevated ARR and PAC were independently associated with GOLD BioAgeDiff, and GOLD BioAgeDiff was correlated with LVMI/eLVMI and may be involved in the association between ARR and eLVMI. Prospective studies are required to confirm causality and evaluate the clinical utility of this biological aging marker.

Primary aldosteronism (PA) independently increases renal impairment risk beyond blood pressure effects. Although hyperaldosteronism is known to mediate renal injury, associations between plasma aldosterone concentration (PAC) and early kidney damage biomarkers such as retinol-binding protein (RBP) and β2-microglobulin (β2-MG) remain insufficiently explored. We investigated the association of PAC with renal function indicators-including RBP, β2-MG, albumin-to-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR)-comparing matched patients with PA and essential hypertension (EH). In this cross-sectional study, 546 PA patients and 546 propensity score-matched EH patients were assessed. Spearman correlations and multivariate regression analyses assessed PAC-renal marker associations, with interactions tested to determine differences between PA and EH groups. In PA, PAC strongly correlated with lower eGFR (r = -0.597, p < 0.001) and higher RBP (r = 0.559), β2-MG (r = 0.632), and ACR (r = 0.583), persisting after adjustment. In contrast, EH patients showed only weak correlations between PAC and eGFR (r = -0.204, p < 0.001), without links with other markers. Interaction analysis confirmed stronger PAC-biomarker associations in PA than EH (all p < 0.05). This study is the first to demonstrate robust associations between PAC and sensitive early renal damage biomarkers, especially RBP, in PA patients, distinct from matched EH patients. It highlights hyperaldosteronism's unique pathogenic role in renal impairment in PA, suggesting early biomarker monitoring and aldosterone-targeted interventions could reduce chronic kidney disease risk in PA populations.