Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
Am J Hypertens. 2012 Jul;25(7):777-83. doi: 10.1038/ajh.2012.33. Epub 2012 Apr 5.
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.
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).
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.
These results suggest that high ARR, that is, relative aldosterone excess, is a predictor for stroke under conditions of high sodium intake.
醛固酮被认为对心血管系统有有害影响。醛固酮与肾素比值（ARR）比单独的醛固酮水平更具可重复性，并且可以作为醛固酮分泌或活性不当的指标。我们之前报告了高钠摄入人群中 ARR 与高血压之间的明显关系。这项前瞻性研究调查了一般人群中 ARR 对钠摄入量分层的首次中风风险。
我们从未接受抗高血压治疗的 Ohasama 一般人群中的 883 名年龄≥35 岁的参与者中获得了血浆肾素活性（PRA）和血浆醛固酮浓度（PAC）（平均年龄：59.0±11.3 岁；65.6%为女性）。
在平均 10.9 年的随访期间，发生了 45 例中风。中位数 PRA、PAC 和 ARR 分别为 1.2ng/ml/h、6.4ng/dl 和 5.3ng/dl/ng/ml/h。使用 Cox 回归，我们计算了调整性别、年龄、体重指数（BMI）和收缩压后的风险比。在所有参与者中，logARR 与中风之间没有关联。然而，在高钠摄入（≥中位数 4058mg/天（盐当量，10.5g/天））的参与者中，logARR 每增加 1 个标准差，中风的风险比就会增加（风险比：1.49，P=0.04）。在低钠摄入的参与者中没有观察到显著关联（P=0.7）。当我们使用 logPRA 或 logPAC 重复所有分析时，没有发现显著关联。
这些结果表明，高 ARR，即相对醛固酮过多，是高钠摄入条件下中风的预测指标。
