[Analysis of related factors for the occurrence of cardiovascular-renal-metabolic syndrome stage 4 in patients with primary aldosteronism].

Among 397 PA patients, 111 (28.0%) had reached CKM stage 4, 107 (26.9%) were in CKM stage 3, and 179 (45.1%) were in the early CKM stages (0–2).

• Total cohort: 397 PA patients, 231 males and 166 females, mean diagnosis age (51.1±10.9) years.
• Early CKM stage group (stages 0–2): 179 patients (1 in stage 0, 7 in stage 1, 171 in stage 2).
• CKM stage 3 group: 107 patients; CKM stage 4 group: 111 patients.
• Data collected retrospectively from January 2016 to December 2024.

Significant differences in demographic and clinical characteristics were observed across the three CKM stage groups.

• Statistically significant differences among the 3 groups were found in age, gender, PA subtype, body mass index, diastolic blood pressure, systolic blood pressure, and hypertension duration (all P<0.05).
• Proportions of dyslipidemia, diabetes, atherosclerosis, chronic kidney disease, cerebral infarction, and coronary heart disease also differed significantly across groups (all P<0.05).

Multiple laboratory indicators differed significantly across the three CKM stage groups.

• Statistically significant differences were found in fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, γ-glutamyl transferase, blood potassium, serum creatinine, urinary albumin/creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR) (all P<0.05).
• Supine aldosterone and aldosterone 2 hours after the captopril test also differed significantly across the 3 groups (P<0.05).

2-hour post-captopril aldosterone was independently and positively associated with the occurrence of CKM stage 4 in PA patients after multivariate adjustment.

• Multivariate logistic regression: OR=1.003, 95% CI: 1.001–1.005.
• Confounding factors adjusted for included gender, age, BMI, metabolic indicators, disease history, and medication history.
• The association remained significant after stepwise adjustment for confounding factors.

The association between 2-hour post-captopril aldosterone and CKM stage 4 was more significant in male patients.

• Male subgroup: OR=1.005, 95% CI: 1.002–1.008.
• This was stronger than the overall cohort association (OR=1.003).
• The correlation showed heterogeneity across populations with different genders.

The association between 2-hour post-captopril aldosterone and CKM stage 4 was more significant in PA patients aged ≤50 years.

• Age ≤50 years subgroup: OR=1.006, 95% CI: 1.002–1.010.
• The association showed heterogeneity across different age groups.
• Subgroup analyses were conducted by age ≤50 years vs. >50 years.

The association between 2-hour post-captopril aldosterone and CKM stage 4 was more significant in the idiopathic hyperaldosteronism (IHA) subgroup compared to aldosterone-producing adenoma.

• IHA subgroup: OR=1.005, 95% CI: 1.002–1.008.
• Subgroup analyses were conducted by PA subtypes: idiopathic hyperaldosteronism (IHA) and aldosterone-producing adenoma.
• The correlation presented heterogeneity across PA subtypes.