Abstract Body: INTRODUCTION Hypertension (HTN) is the leading cause of premature death in women. Apparent treatment-resistant hypertension (aTRH) is systolic blood pressure (SBP) ≥140 or diastolic BP (DBP) ≥90 mmHg despite treatment with ≥3 antihypertensive medications, or the use of ≥4 antihypertensive medications (irrespective of the BP level). aTRH occurs in approximately 17% of people with treated HTN. High aldosterone may elevate cardiovascular risk; despite causing sodium retention, aldosterone may paradoxically continue to be secreted even when dietary sodium intake is high. Little is known, however, about how aldosterone relates to BP and HTN in women, in whom significant increases in BP, carotid atherosclerosis, and arterial stiffness occur near the time of menopause. We examined the relationships of aldosterone with HTN and aTRH in a cohort of post-menopausal women.

METHODS The Study of Women’s Health Across the Nation (SWAN) is a longitudinal cohort of women followed from midlife into late adulthood. This cross-sectional analysis included 999 women (30.3% of the cohort) free of congestive heart failure and with serum aldosterone measured during the 2015-2016 (15th follow-up) study visit. HTN was defined as SBP or DBP ≥140 or ≥90 mmHg, respectively, or use of antihypertensive medications. aTRH was defined as reported use of 4 or more concurrent antihypertensive medications at any visit, or 3 or more concurrent medications and SBP≥140 or DBP≥90 at two consecutive visits. Multivariable logistic regression related HTN or aTRH and aldosterone, adjusting for age, race/ethnicity, and body mass index.

RESULTS In this cohort of women [mean age 66 years (standard deviation:2.7)], the prevalence of HTN and aTRH was 52% and 4.1%, respectively. Women with aTRH had higher median serum aldosterone [8.7 ng/dL, interquartile range (IQR) 5.0-11.7] versus those without (6.7 ng/dL, IQR 2.7-10.5). Each unit increase in aldosterone was associated with a 4% increased odds of HTN (95%CI 1.02,1.06; p<0.001). Similarly, the odds ratio for aTRH in the adjusted model was 1.04 (95%CI 0.99,1.08), although the association was not statistically significant (p=0.09).

CONCLUSION Aldosterone was positively associated with HTN and there was a non-statistically significant trend toward an association with aTRH in this cohort of post-menopausal women. Our findings suggest that aldosterone within an ostensibly “normal” range is associated with HTN in postmenopausal women.