Plasma Aldosterone Elevation in Hypertensive Patients and Association with Urinary Stone Formation: A Large-Scale Population Study from Northwest China

Shuaiwei Song,1– 5,* Nanfang Li,1– 5,* Di Shen,1– 5 Junli Hu,1– 5 Xintian Cai,1– 5 Qing Zhu,1– 5 Yingying Zhang,1– 5 Rui Ma,1– 5 Pan Zhou,1– 5 Zhiqiang Zhang,1– 5 Wen Jiang,1– 5 Jing Hong1– 5 1Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830001, People’s Republic of China; 2Xinjiang Hypertension Institute, Urumqi, Xinjiang, 830001, People’s Republic of China; 3NHC Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, 830001, People’s Republic of China; 4Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Urumqi, Xinjiang, 830001, People’s Republic of China; 5Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang, 830001, People’s Republic of China*These authors contributed equally to this workCorrespondence: Nanfang Li, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Urumuqi, Urumqi, Xinjiang, People’s Republic of China, 830001, Tel +86 8564818, Email lnanfang2016@sina.comBackground: Previous studies have suggested a potential association between plasma aldosterone concentration (PAC) and calcium regulation. However, it remains unclear whether elevated PAC levels increase the risk of urinary stones. Therefore, this study aimed to investigate the relationship between PAC levels and urinary stones, including their subtypes, in patients with hypertension.Methods: This large-scale study included a total of 35161 hypertensive patients. Multivariable logistic regression was used to analyze the association between PAC levels and urinary stones, as well as their subtypes. Additionally, a dose-response relationship was explored using restricted cubic spline (RCS) analysis, and a two-stage comparative analysis was conducted based on the RCS turning point. The importance of PAC was further confirmed through variable importance analysis. Finally, extensive subgroup analyses and sensitivity analyses were performed to assess the robustness of the findings.Results: Multivariable logistic regression revealed a significant association between elevated PAC levels and the occurrence of urinary stones and their subtypes. Specifically, for every 5 ng/dL increase in PAC, the risk of urinary stones increased by 26% (odds ratios [OR] 1.26, 95% confidence interval [CI], 1.22– 1.30, P< 0.001). Furthermore, RCS threshold analysis demonstrated a marked increase in urinary stone risk when PAC levels exceeded 14.2 ng/dL (OR 1.50, 95% CI, 1.38– 1.63, P< 0.001). These findings were consistent across subtypes, including kidney stones and ureteral stones. Subgroup analyses showed that the results were unaffected by stratification factors, and sensitivity analyses further confirmed the stability of the findings.Conclusion: This study demonstrated that elevated PAC levels are significantly associated with the occurrence of urinary stones and their subtypes in hypertensive patients. These findings suggest that controlling PAC levels in hypertensive patients may help reduce the risk of urinary stone formation. Keywords: Plasma aldosterone concentration, primary aldosteronism, Hypertension, Parathyroid hormone

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