A primary aldosteronism-like phenotype identified with the aldosterone-to-angiotensin II ratio in black men: the SABPA study

Cardiovasc J Afr. 2020;31(3):130-135. doi: 10.5830/CVJA-2019-059. Epub 2019 Nov 27.


Introduction: Black populations may be more likely to have primary aldosteronism (PA) due to adrenal hyperplasia or other forms of adrenal hyperactivity, with suppressed renin levels and high levels of aldosterone, which may contribute to the development of hypertension.

Methods: This sub-study involved 35 black men matched for age, gender and race, and aged 20-65 years, living in the North West Province of South Africa. RAAS triple-A analysis was carried out with LC-MS/MS quantification. Blood pressure, electrocardiography and other variables were determined with known methods.

Results: Hypertensive subjects with higher aldosterone levels showed an increased aldosterone-angiotensin II ratio (AA2 ratio) compared to the hypertensive subjects with low aldosterone levels (10.2 vs 3.0 pmol/l; p = 0.003). The serum potassium concentration was significantly lower in the high-aldosterone group and the serum sodium-potassium ratio was significantly higher compared to the low-aldosterone group (3.9 vs 4.5, p = 0.016, 34.8 vs 31.8, p = 0.032, respectively). Furthermore, aldosterone was positively associated with both left ventricular hypertrophy (Cornell product) (Spearman R = 0.560; p = 0.037) and kidney function [albumin-to-creatinine ratio (ACR) ] (Spearman R = 0.589, p = 0.021) in the hypertensive high-serum aldosterone group.

Conclusions: The AA2 ratio, a novel screening test that is currently being validated for PA case detection, was used to identify a PA-like phenotype in black men. Excess aldosterone was associated with endothelial dysfunction and left ventricular hypertrophy, independent of blood pressure.

Keywords: RAAS; aldosterone; blacks; hypertension; organ damage.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aldosterone / blood*
  • Angiotensin II / blood*
  • Biomarkers / blood
  • Black People*
  • Blood Pressure
  • Humans
  • Hyperaldosteronism / blood
  • Hyperaldosteronism / diagnosis
  • Hyperaldosteronism / ethnology*
  • Hyperaldosteronism / physiopathology
  • Hypertension / blood
  • Hypertension / diagnosis
  • Hypertension / ethnology*
  • Hypertension / physiopathology
  • Hypertrophy, Left Ventricular / blood
  • Hypertrophy, Left Ventricular / diagnosis
  • Hypertrophy, Left Ventricular / ethnology*
  • Hypertrophy, Left Ventricular / physiopathology
  • Male
  • Middle Aged
  • Phenotype
  • Race Factors
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • South Africa
  • Ventricular Function, Left
  • Ventricular Remodeling
  • Young Adult


  • Biomarkers
  • Angiotensin II
  • Aldosterone