Why Elevated Aldosterone Levels Could Be Sabotaging Your Blood Pressure
If you’re taking multiple medications for high blood pressure but it still won’t budge you’re not alone. Millions of people around the world suffer from resistant or uncontrolled hypertension, a form of high blood pressure that remains elevated despite treatment. But what if the real culprit isn’t your heart or lifestyle, but a tiny hormone with a big impact?
Meet aldosterone, a hormone that plays a critical role in regulating blood pressure. When produced in excess, it can silently fuel chronic hypertension that resists even the best treatment plans.
In this article, we’ll explore how elevated aldosterone levels contribute to resistant hypertension, how to recognize this hidden problem, and what treatment options can make all the difference.
What Is Aldosterone?
Aldosterone is a hormone made by the adrenal glands, located on top of the kidneys. It helps regulate:
- Sodium and water retention
- Potassium excretion
- Blood volume and blood pressure
In a healthy person, aldosterone levels rise and fall to maintain fluid balance. But when aldosterone is consistently too high, the body retains excess sodium and water leading to increased blood volume and blood pressure.
What Is Resistant Hypertension?
Resistant hypertension is diagnosed when a person’s blood pressure remains above 140/90 mmHg (or 130/80 mmHg for high-risk individuals), despite using three or more different blood pressure medications, one of which should be a diuretic.
It’s a red flag that something deeper like hormonal imbalance might be driving the problem.
The Aldosterone Connection
One of the most common but overlooked causes of resistant hypertension is primary aldosteronism (PA), also known as Conn’s syndrome. In this condition, the adrenal glands produce too much aldosterone, usually due to:
- A benign tumor (adenoma)
- Adrenal gland overgrowth (hyperplasia)
The result? Persistent high blood pressure and low potassium levels (hypokalemia), often without clear symptoms.
Research suggests that up to 10–20% of people with resistant hypertension may have undiagnosed primary aldosteronism.
Signs You May Have Aldosterone-Driven Hypertension
You should suspect excess aldosterone if you have:
- High blood pressure that’s hard to control
- Normal or low potassium levels, especially without supplements
- Muscle cramps or weakness
- Frequent urination or excessive thirst
- High blood pressure at a young age (under 40)
- A family history of early-onset hypertension or stroke
Since aldosterone-driven hypertension often presents without symptoms, it’s crucial to test for it in people with resistant or unexplained high blood pressure.
How Is Aldosterone Measured?
Testing typically begins with a blood test called the aldosterone-renin ratio (ARR), which measures:
- Plasma aldosterone concentration (PAC)
- Plasma renin activity (PRA)
An elevated ARR suggests that aldosterone is high and renin is suppressed, a classic sign of primary aldosteronism.
If the ARR is abnormal, your doctor may recommend:
- Confirmatory testing (e.g., saline infusion test)
- Imaging (CT scan of the adrenal glands)
- Adrenal vein sampling (to pinpoint which gland is overproducing)
At Erdem Hospital, our endocrinology and hypertension specialists use advanced testing to identify hidden hormonal causes behind treatment-resistant cases.
How Is It Treated?
Treatment depends on the underlying cause of the aldosterone excess:
1. Aldosterone-Producing Adenoma (Unilateral)
- Surgical removal of the affected adrenal gland (laparoscopic adrenalectomy)
- Can cure or significantly improve blood pressure control
2. Bilateral Adrenal Hyperplasia
- Treated with mineralocorticoid receptor blockers, such as:
- Spironolactone
- Eplerenone
- Spironolactone
These medications block aldosterone’s effects, lower blood pressure, and help normalize potassium levels.
Why It Matters
Uncontrolled aldosterone levels do more than just raise blood pressure. Over time, they can:
- Harden blood vessels (arterial stiffness)
- Cause left ventricular hypertrophy (heart thickening)
- Increase risk for stroke, heart failure, and kidney disease
That’s why early detection and treatment can reduce long-term complications and improve quality of life even in patients who have struggled with high blood pressure for years.
Frequently Asked Questions (FAQ)
1. Can I have high aldosterone with normal potassium levels?
Yes. Up to 50% of patients with primary aldosteronism have normal potassium so a normal potassium level does not rule it out.
2. Is aldosterone tested in routine bloodwork?
No. Aldosterone levels are not part of standard panels. They require specific hormonal testing, usually ordered by a hypertension specialist or endocrinologist.
3. Is primary aldosteronism curable?
In many cases, yes. If the cause is a tumor in one adrenal gland, surgery can offer a permanent cure. If both glands are involved, medication is usually effective.
4. Should I be tested for aldosterone if I have high blood pressure?
Testing is recommended if you have resistant hypertension, low potassium, early-onset hypertension, or a family history of stroke or cardiovascular disease.
5. What if I already take multiple blood pressure meds and still struggle?
This is exactly when aldosterone excess should be considered. Ask your doctor about hormonal testing or speak with a specialist.
Don’t Let a Hidden Hormone Sabotage Your Heart
High blood pressure isn’t always caused by stress or salt. Sometimes, the problem lies deeper in your adrenal glands. If your hypertension is stubborn, unexplained, or runs in the family, elevated aldosterone could be the missing piece.
At Erdem Hospital, our team of hypertension and endocrine experts is committed to uncovering and treating the hidden causes behind resistant blood pressure with over 37 years of clinical excellence guiding every decision.