Aldosterone Identifies a High-Risk Recurrent Phenotype in Severe Hypertension

Acute severe hypertension represents a frequent cause of emergency department visits and hospital admissions, yet its underlying biological heterogeneity is insufficiently understood. While classical secondary causes such as primary aldosteronism have been extensively studied, emerging evidence suggests that a broader continuum of aldosterone dysregulation may contribute to cardiovascular risk, even in the absence of overt endocrine hypertension.

The VATAHTA Acute Study is a multicenter observational cohort including adult patients admitted with acute severe hypertension, defined by markedly elevated blood pressure levels requiring hospital management. The study will systematically collect clinical characteristics, laboratory parameters-including plasma aldosterone, renin levels, and aldosterone-to-renin ratio-and treatment data at admission.

The primary objective is to evaluate the association between aldosterone levels and short-term clinical severity, assessed by length of hospital stay. Secondary objectives include the relationship between aldosterone profiles and target organ damage, biochemical alterations (such as potassium and renal function), and short-term cardiovascular outcomes, including major adverse cardiovascular events (MACE).

Multivariable analyses will be performed to determine whether aldosterone levels are independently associated with clinical severity after adjustment for relevant confounders, including blood pressure at admission, age, sex, renal function, and potassium levels. The study also aims to explore phenotypic patterns consistent with aldosterone dysregulation beyond classical definitions, potentially identifying clinically relevant subgroups.

This study is expected to provide novel insights into the pathophysiology of acute severe hypertension and contribute to improved risk stratification and personalized management strategies.

Inclusion criteria

Adults aged ≥18 years Hospital admission due to acute severe hypertension, defined as systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥120 mmHg requiring in-hospital management Availability of plasma aldosterone and renin measurements at hospital admission or within the first 24 hours Availability of key clinical and laboratory data, including blood pressure, renal function, and serum potassium levels

Exclusion criteria

Pregnancy or hypertensive disorders of pregnancy Known secondary hypertension due to endocrine causes other than suspected aldosterone dysregulation (e.g., pheochromocytoma, Cushing syndrome) Patients receiving chronic dialysis Severe acute conditions likely to independently determine short-term outcomes (e.g., septic shock, major trauma) Missing key data required for primary outcome assessment (length of hospital stay) Prior inclusion in the study cohort

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