Satoh Michihiro, Kikuya Masahiro, Hosaka Miki, Asayama Kei, Inoue Ryusuke, Metoki Hirohito, Tsubota-Utsugi Megumi, Hara Azusa, Hirose Takuo, Obara Taku, Mori Takefumi, Totsune Kazuhito, Hoshi Haruhisa, Mano Nariyasu, Imai Yutaka, Ohkubo Takayoshi
Department of Pharmacy, Tohoku University Hospital, Sendai, Japan;
Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan;
Am J Hypertens. 2015 Feb;28(2):208-15. doi: 10.1093/ajh/hpu115. Epub 2014 Jun 23.
In cross-sectional studies, the aldosterone-to-renin ratio (ARR) has been reported to be associated with hypertension under conditions of higher sodium intake. The objective of this prospective study was to investigate the association between ARR and the development of hypertension in community residents stratified by dietary sodium intake.
From the general population of Ohasama, we obtained plasma renin activity (PRA) and plasma aldosterone concentrations (PACs) for 608 participants (mean age = 57.6 years; 71.4% women) without hypertension at baseline. Using the Cox model, we computed the adjusted hazard ratio (HR) of natural log-transformed ARR (lnARR) for the development of hypertension, defined as blood pressure ≥140/90mm Hg or start of treatment with antihypertensive drugs during follow-up.
During a mean follow-up of 6.8 years, 298 participants developed hypertension. The median PRA, PAC, and ARR were 1.2ng/ml/hour, 6.6ng/dl, and 5.5ng/dl per ng/ml/hour, respectively. Each 1 SD increase in lnARR was associated with an increased risk for the development of hypertension in participants overall (HR = 1.18; P = 0.007). In participants with higher sodium intake (median ≥4,102mg/day), a significant association of lnARR with hypertension remained (HR = 1.25; P = 0.009), whereas no significant association was observed in participants with lower sodium intake (P = 0.18). Participants who developed hypertension had significantly lower PRA than those who did not (P = 0.003), despite no differences in PAC (P = 0.91).
These results raise the hypothesis that relative aldosterone excess may have a deleterious effect on the development of hypertension by contributing to salt/volume-related hypertension.
在横断面研究中，据报道，在高钠摄入情况下，醛固酮与肾素比值（ARR）与高血压有关。这项前瞻性研究的目的是调查按饮食钠摄入量分层的社区居民中，ARR与高血压发生之间的关联。
从大岛的普通人群中，我们获取了608名基线时无高血压的参与者（平均年龄 = 57.6岁；71.4%为女性）的血浆肾素活性（PRA）和血浆醛固酮浓度（PAC）。使用Cox模型，我们计算了自然对数转换后的ARR（lnARR）对高血压发生的校正风险比（HR），高血压定义为随访期间血压≥140/90mmHg或开始使用抗高血压药物治疗。
在平均6.8年的随访期间，298名参与者患上了高血压。PRA、PAC和ARR的中位数分别为1.2ng/ml/小时、6.6ng/dl和5.5ng/dl per ng/ml/小时。lnARR每增加1个标准差，总体参与者患高血压的风险就增加（HR = 1.18；P = 0.007）。在钠摄入量较高（中位数≥4102mg/天）的参与者中，lnARR与高血压之间仍存在显著关联（HR = 1.25；P = 0.009），而在钠摄入量较低的参与者中未观察到显著关联（P = 0.18）。患高血压的参与者的PRA显著低于未患高血压的参与者（P = 0.003），尽管PAC无差异（P = 0.91）。
这些结果提出了一个假设，即相对醛固酮过多可能通过导致盐/容量相关的高血压，对高血压的发生产生有害影响。
