Blood Pressure Patterns and Cardio-Renal Complications in Primary Aldosteronism Compared with Essential Hypertension in a Tunisian Population

Primary aldosteronism (PA) is a major cause of secondary hypertension associated with increased target organ damage beyond the effects of blood pressure (BP). This study aimed to compare BP characteristics and cardio-renal complications between patients with PA and essential hypertension (EH) in a Tunisian population. We conducted a retrospective study of 227 hospitalized patients (112 with PA and 115 with EH) at a tertiary care center between 2003 and 2023. Clinical, biological, and cardiovascular data were analyzed. Multivariate regression analysis was used to identify independent factors associated with target organ damage, which were more prevalent in PA. Patients with PA had longer hypertension duration, higher systolic and diastolic BP levels, and a higher prevalence of resistant hypertension. Chronic kidney disease (CKD) and left ventricular hypertrophy (LVH) were significantly more frequent in patients with PA (28.7 vs 14.4%; p = 0.01 and 47.4 vs 16.7%; p < 0.001, respectively). After multivariable adjustment, PA remained independently associated with LVH (aOR= 3.1; 95% CI [1.2-7.9]; p = 0.02), whereas its association with CKD was attenuated (p = 0.06; aOR: 2.0 [1.0-4.2]). Baseline aldosterone showed good discriminative ability for LVH (AUC = 0.715; 95% CI: [0.627-0.803]; p < 0.001), with an optimal cut-off value of 135.7 pg/mL. In conclusion, PA was associated with more severe hypertension and a markedly increased risk of LVH compared with EH, supporting a direct deleterious cardiac effect of aldosterone excess and underscoring the importance of early diagnosis and targeted treatment.