Primary Aldosteronism and COVID-19-related Management, Disease Severity, and Outcomes: A Retrospective Cohort Study

Abstract

Context The SARS-CoV2 virus is dependent on components of the renin-angiotensin-aldosterone system(RAAS) for infectivity. Primary aldosteronism (PA) is a form of secondary hypertension mediated by autonomous aldosterone production. The intersection of COVID-19 and PA, both which may involve components of the RAAS, remains unknown. Methods We assessed PA as a risk factor for COVID-19 infection and compared management, severity of disease, and outcomes during COVID-19 with a matched population of essential hypertension(EH) patients by conducting a retrospective observational cohort study. Results Of the PA patients, 81 patients had a negative PCR test for COVID-19, while 43 patients had a documented positive PCR test for COVID-19. Those PA patients who tested positive for COVID-19 tended to be female(P = 0.08) and the majority of those with COVID-19 infection identified as non-white race(P = 0.02) and Hispanic ethnicity(P = 0.02). In a subanalysis, 24-hour urine aldosterone upon initial PA diagnosis tended to be higher in the PA group who developed COVID-19 compared to the PA group that did not develop COVID-19[36.5(16.9, 54.3) vs. 22.0(15.8, 26.8)mcg, P = 0.049] and was an independent predictor of COVID-19 infection controlling for sex, race, and ethnicity. ACEi, ARB, and MR use did not differ between those PA patients with and without COVID-19 infection. Comparing those PA and matched EH patients(n = 286) who were COVID-19 PCR positive, there was a significantly higher incidence of cardiovascular complications(12 vs. 2%, P = 0.004) in the PA vs. EH group. Conclusion These data begin to inform us as to whether PA should be a newly identified subpopulation at risk for COVID-19-related cardiovascular disease sequelae.