Aldosterone-to-Renin Ratio as a Predictor of Stroke Under Conditions of High Sodium Intake : The Ohasama Study
Aldosterone-to-Renin Ratio as a Predictor of Stroke Under Conditions of High Sodium Intake : The Ohasama Study
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高钠摄入条件下醛固酮与肾素比率作为中风的预测因子：Ohasama 研究
DOI：
10.1038/ajh.2012.33
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发表时间：
2012
期刊：
影响因子：
3.2
通讯作者：
Imai Y.
中科院分区：
文献类型：
--
作者：
Satoh M;Kikuya M;Ohkubo T;Mori T;Metoki H;Hara A;Utsugi MT;Hashimoto T;Hirose T;Obara T;Inoue R;Asayama K;Kanno A;Totsune K;Hoshi H;Satoh H;Imai Y.
研究背景醛固酮对心血管系统有不良影响。醛固酮与肾素比值（ARR）比单独的醛固酮水平更具有可重复性，可能是醛固酮分泌或活性不适当的指标。我们以前曾报道过高钠摄入者ARR与高血压之间的明显关系。这项前瞻性研究调查了ARR的风险为第一次中风的一般人口分层钠intake.MethodsWe获得了血浆肾素活性（PRA）和血浆醛固酮浓度（PAC）的883名参与者年龄≥35岁没有接受降压治疗的一般人口Ohasama（平均年龄：59.0 ± 11.3岁; 65.6%为女性）。中位PRA、PAC和ARR分别为1.2 ng/ml/h、6.4 ng/dl和5.3 ng/dl/ng/ml/h。使用考克斯回归，我们计算了校正了性别、年龄、体重指数（BMI）和收缩压的风险比。在总体受试者中未观察到logARR与卒中之间的相关性。然而，在高钠摄入量（≥中位数4，058 mg/天（盐当量，10.5 g/天））的受试者中，每1 s.d. logARR增加与卒中风险比增加相关（风险比：1.49，P = 0.04）。在低钠摄入的受试者中未观察到显著相关性（P= 0.7）。当我们使用logPRA或logPAC重复所有分析时，没有发现任何显着的相关性。结论这些结果表明，高ARR，即相对醛固酮过量，是高钠摄入条件下中风的预测因素。
BackgroundAldosterone 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.MethodsWe 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).ResultsOver 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.ConclusionThese results suggest that high ARR, that is, relative aldosterone excess, is a predictor for stroke under conditions of high sodium intake.