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Abstract: SA-PO540

Prevalence of Aldosterone Breakthrough in a Cardiometabolic Clinic and Association with Albuminuria

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical


  • Imcaoudene, Ahmed Rateb, McGill University Health Centre, Montreal, Quebec, Canada
  • Najjar, Caroline, McGill University Health Centre, Montreal, Quebec, Canada
  • Marques, Pedro, McGill University Health Centre, Montreal, Quebec, Canada
  • Tsoukas, Michael A., McGill University Health Centre, Montreal, Quebec, Canada
  • Sharma, Abhinav, McGill University Health Centre, Montreal, Quebec, Canada
  • Mavrakanas, Thomas, McGill University Health Centre, Montreal, Quebec, Canada

Type 2 diabetes (T2D) and chronic kidney disease (CKD) patients have cardiovascular and renal benefits when treated with renin-angiotensin system (RAS) blockers. Some of these patients are known to exhibit a rise in aldosterone levels while on RAS blockers, called aldosterone breakthrough. The aim of our study is to assess the prevalence of aldosterone breakthrough in our clinic and its association with albuminuria.


Patients from a cardiometabolic clinic with available plasma aldosterone concentration (PAC) levels were screened. Exclusion criteria included: not taking a RAS blocker for at least 10 months, current treatment with a mineralocorticoid receptor antagonist (MRA) and an Aldosterone to renin ratio suggestive of primary hyperaldosteronism. Patients with a PAC>400pmol/L were considered to have aldosterone breakthrough.


64 patients met the inclusion criteria with 21 (33%) showing aldosterone breakthrough. Patient characteristics are shown in the Table. No significant differences in baseline characteristics were seen in patients with or without aldosterone breakthrough except for higher albuminuria in the breakthrough group. The prevalence of CKD was numerically higher in the breakthrough group. Similar trends were seen when aldosterone breakthrough was defined as a PAC level above the median of our sample.


Aldosterone breakthrough is prevalent in patients from a cardiometabolic clinic and is associated with higher albuminuria. Patients with aldosterone breakthrough can potentially draw more benefit when treated with an MRA.

Baseline characteristics based on the presence or absence of aldosterone breakthrough
CharacteristicAldosterone breakthroughNo aldosterone breakthroughp value
Age (years, median [IQR])67 (64-77)67 (61-75)0.58
Sex (male, [n,%])15 (71)28 (65)0.61
Hypertension (n, %)19 (90)37 (86)0.62
Type 2 diabetes (n, %)20 (95)40 (93)0.73
Heart Failure (n, %)13 (62)23 (53)0.52
Chronic kidney disease* (n, %)16 (76)22 (51)0.06
SGLT2i (n, %)16 (76)35 (81)0.63
Albuminuria (mg/g, [median (IQR)])264 (76-1118)34 (0-1013)0.02
PAC (pmol/L, [median (IQR)])549 (498-839)227 (151-291)<0.01

*defined as eGFR<60mL/min/1.73m2 IQR - Interquartile range; PAC - Plasma aldosterone concentration; SGLT2i - sodium-glucoseco-transporter 2 inhibitors.