Association of aldosterone-to-renin ratio with hypertension differs by sodium intake: the Ohasama study.
Association of aldosterone-to-renin ratio with hypertension differs by sodium intake: the Ohasama study.
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醛固酮/肾素比率与高血压的关联因钠摄入量而异：Ohasama 研究。
DOI：
10.1093/ajh/hpu115
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
et al.
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作者：
Satoh M;Kikuya M;Hosaka M;et al.
背景在横断面研究中，据报道，醛固酮与肾素比值（ARR）在钠摄入量较高的情况下与高血压相关。这项前瞻性研究的目的是调查按膳食钠摄入量分层的社区居民 ARR 与高血压发生之间的关联。方法我们从 Ohasama 的一般人群中获得了 608 名基线时没有高血压的参与者（平均年龄 = 57.6 岁；71.4% 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 ARR (lnARR) 发生高血压的调整风险比 (HR)，高血压定义为血压≥140/90mm Hg 或在随访期间开始接受抗高血压药物治疗。 结果在平均随访 6.8 年期间，298 名参与者出现高血压。中位 PRA、PAC 和 ARR 分别为 1.2 ng/ml/小时、6.6 ng/dl 和 5.5 ng/dl/ng/ml/小时。 lnARR 每增加 1 个 SD，参与者整体患高血压的风险就会增加（HR = 1.18；P = 0.007）。在钠摄入量较高的参与者（中位值≥4,102mg/天）中，lnARR 与高血压仍然存在显着关联（HR = 1.25；P= 0.009），而在钠摄入量较低的参与者中没有观察到显着关联（P = 0.18）。尽管 PAC 没有差异 (P = 0.91)，但发生高血压的参与者的 PRA 显着低于未发生高血压的参与者 (P = 0.003)。结论这些结果提出了这样的假设：相对醛固酮过量可能会导致盐/容量相关的高血压，从而对高血压的发生产生有害影响。
BACKGROUNDIn 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.METHODSFrom 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.RESULTSDuring 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).CONCLUSIONSThese 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.