Primary aldosteronism (PA) is the most frequent form of secondary endocrine hypertension, which is characterized by excessive aldosterone secretion and suppressed renin. The currently recommended diagnostic algorithm is very clear, and the plasma aldosterone-to-renin ratio (ARR) is considered the first-line screening test. However, this indicator is influenced by many factors, some of which may cause false-negative results, consequently leading to underdiagnosed PA. Here, we report the rare case of a 38-year-old man who presented with bilateral accessory renal arteries and aldosterone-producing adenoma but had a negative ARR test result.

Objectives Ascending aorta dilatation (AAD) has been suggested as a surrogate marker for vascular organ damage in the hypertensive population. However, limited data are available on AAD in normotensive individuals. This study aims to preliminarily explore the correlation between ascending aorta (AAO) and other established clinically significant target organ damage parameters and to investigate the possible risk factors of AAD in the non-diabetic normotensive individuals. Design Our study has a cross-sectional design. Setting All participants were recruited from the inpatient and outpatient departments of our hospital. Participants We recruited 634 normotensive participants (52.26±16.22 years, 39.43% male) who underwent both ambulatory blood pressure monitoring (ABPM) and echocardiography. The whole study population was divided into AAD and non-AAD groups according to age-gender-specific criteria. The baseline mean blood pressure (BP) of the two groups was 126.92/77.72 and 124.16/77.61 mm Hg, respectively. Primary and secondary outcome measures The relationship between AAO and other acknowledged cardiac damage indicators, as well as the associations of AAD with ABPM indexes in the non-diabetic normotensive individuals. Results We observed that AAO exhibited a significant correlation with left ventricular mass index (β=1.905, p<0.001), e’ (β=−0.324, p<0.001) and E/e’ (β=0.221, p<0.001). Among all the ABPM indexes, only those related to diastolic BP (DBP), specifically 24-hour DBP (OR=1.056, 95% CI 1.004 to 1.110, p<0.05) and night-time DBP (OR=1.071, 95% CI 1.011 to 1.134, p<0.05), were associated with AAD after adjustment for age, gender and other confounders. Furthermore, in the multivariate forward logistic regression analysis, night-time DBP was most strongly associated with AAD (OR=1.064, 95% CI 1.008 to 1.124, p<0.05). Conclusions We found that AAO was correlated with alterations in other acknowledged cardiac parameters, both structural and functional, in non-diabetic normotensive individuals, indicating AAD may be significant in these individuals. Notably, DBP, especially night-time DBP, showed a more significant correlation with AAD. Trial registration number ChiCTR2000030677.