Prevalence of abnormal markers for primary aldosteronism in acute stroke — ASN Events
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  3. Prevalence of abnormal markers for primary aldosteronism in acute stroke

Prevalence of abnormal markers for primary aldosteronism in acute stroke (#305)

Josephine McCarthy 1 2 3 4 , Luca Massimino 1 , Catherine He 2 , Muhammad Akram 2 , Peter J Fuller 2 3 , Philip M.C. Choi 5 6 , Thanh G Phan 1 7 , Jun Yang 1 2 3
  1. Department of Medicine in the School of Clinical Sciences, Monash Health, Clayton, Victoria, Australia
  2. Centre for Endocrinology and Reproductive Health, Hudson Institute of Medical Research , Hudson, Clayton, VIC, Australia
  3. Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
  4. Endocrinology & Diabetes, Eastern Health, Box Hill, Victoria
  5. Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Victoria, Australia
  6. Department of Neuroscience, Eastern Health, Neuroscience BHH, Box Hill, Victoria, Australia
  7. Department of Neurology, Monash Health, Clayton, Victoria, Australia

Aims: Primary aldosteronism (PA) is a condition of dysregulated adrenal aldosterone production characterised by a normal or high aldosterone concentration relative to a low or suppressed renin. PA is associated with increased cardiovascular risk including stroke, compared to essential hypertension and has targeted treatment. This study aimed to establish the prevalence of PA in patients admitted with stroke in Australia.

 

Methods: A prospective multi-centre cohort study was conducted at two tertiary hospitals in Victoria, Australia. Adult patients admitted for stroke or transient ischaemic attack (TIA) were recruited consecutively during investigator ward rounds between June 2023 and December 2025. Inclusion criteria were: ≥18 years old, admitted for stroke or TIA. Exclusion criteria related to poor prognosis, traumatic stroke or conditions that preclude interpretation of aldosterone and renin. Data including demographics, medications, blood pressure, cortisol, potassium, aldosterone and renin were collected in the emergency department, stroke ward and three months post discharge. PA status was classified as 'likely' or 'unlikely' according to 2025 Endocrine Society criteria. A pragmatic local definition of 'PA possible' was applied using modified criteria to account for interfering medications or hypokalaemia.

 

Results: Of 263 patients (mean age 70.1 years (SD 15.1), 63% male), two had likely PA, 78 had possible PA, and 183 PA unlikely. The group with possible PA had higher systolic blood pressure on hospital presentation compared to the group with PA unlikely [163mmHg (SD 30.3) vs 149mmHg (SD 26.2), p 0.001]. Aldosterone levels were lower during the acute admission compared to three months later in the overall cohort.

 

Conclusion: Nearly one third of the stroke patient cohort had likely or possible PA; the prevalence was even higher in those with hypertension.  Our data suggest that screening for PA in all patients with stroke or TIA may enable earlier diagnosis and targeted treatment of PA.