Journal
AMERICAN JOURNAL OF HYPERTENSION
Volume 25, Issue 7, Pages 777-783Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/ajh.2012.33
Keywords
aldosterone-to-renin ratio; blood pressure; hypertension; relative aldosterone excess; salt-sensitive hypertension; sodium intake; stroke
Categories
Funding
- Ministry of Education, Culture, Sports, Science, and Technology, Japan [18390192, 18590587, 19590929, 19790423, 20590629, 21390201, 21591016, 22590767, 22790556, 22890017, 23249036, 23790242]
- Ministry of Health, Labor and Welfare, Health and Labor Sciences Research Grants, Japan [H18-Junkankitou[Seishuu]Ippan-012, H20-Junkankitou[Seishuu]-Ippan-009, 013, H23-Junkankitou [Senshuu]-Ippan-005]
- Health Science Research Grants and Medical Technology Evaluation Research Grants from the Ministry of Health, Labor and Welfare, Japan
- Japan Arteriosclerosis Prevention Fund
- Biomedical Innovation Grants
- Miso Central Institute,Tokyo, Japan
- Sendai Knowledge Cluster Initiative, Sendai, Japan
- [18.54042]
- [19.7152]
- [20.7198]
- [20.7477]
- [20.54043]
- Grants-in-Aid for Scientific Research [21390201, 22890017, 23790242] Funding Source: KAKEN
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BACKGROUND Aldosterone is thought to have deleterious effects on the cardiovascular system. The aldosterone-to-renin ratio (ARR) is more reproducible than aldosterone levels alone and could be an index for inappropriate aldosterone secretion or activity. We previously reported the apparent relation between ARR and hypertension in subjects with high sodium intake. This prospective study investigated the risk of ARR for a first stroke in a general population stratified by sodium intake. METHODS We obtained plasma renin activity (PRA) and plasma aldosterone concentrations (PAC) for 883 participants aged >= 35 years not receiving antihypertensive treatment in the general population of Ohasama (mean age: 59.0 +/- 11.3 years; 65.6% women). RESULTS Over a mean of 10.9 follow-up years, 45 strokes occurred. The median PRA, PAC, and ARR were 1.2 ng/ml/h, 6.4 ng/dl, and 5.3 ng/dl per ng/ml/h, respectively. Using Cox regression, we computed hazard ratios adjusted for sex, age, body mass index (BMI), and systolic blood pressure. No association between logARR and stroke was observed in subjects overall. However, in subjects with high sodium intake (>= median of 4,058 mg/day (salt equivalent, 10.5 g/day)), each 1 s.d. increase in logARR was associated with an increased hazard ratio for stroke (hazard ratio: 1.49, P = 0.04). No significant association was observed in subjects with low sodium intake (P = 0.7). When we repeated all the analyses using logPRA or logPAC, no significant associations were found. CONCLUSION These results suggest that high ARR, that is, relative aldosterone excess, is a predictor for stroke under conditions of high sodium intake.
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