Serum aldosterone and the incidence of hypertension in nonhypertensive persons
Serum aldosterone and the incidence of hypertension in nonhypertensive persons
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DOI：
10.1056/nejmoa033263
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发表时间：
2004-07-01
影响因子：
158.5
通讯作者：
Levy, D
中科院分区：
文献类型：
--
作者：
Vasan, RS;Evans, JC;Levy, D
背景：原发性高醛固酮增多症是继发性高血压的一个公认原因。目前尚不清楚生理范围内的血清醛固酮水平是否会影响高血压的风险。方法：我们调查了1688名Framingham后代研究（平均年龄55岁）非高血压参与者的基线血清醛固酮水平与4年后血压升高和高血压发病率的关系，其中58%为女性。我们将血压升高定义为至少一种血压类别的增加（由高血压预防、检测、评估和治疗全国联合委员会定义），并将高血压定义为收缩压为140毫米汞柱或更高，舒张压为90毫米汞柱或更高，或使用抗高血压药物。结果：在随访中，33.6%的参与者血压升高，14.8%的参与者出现高血压。在多变量模型中，观察到血清醛固酮水平每增加四分位数，血压升高的风险增加16% (P=0.002)，高血压风险增加17% （P=0.03）。与最低的四分位数相比，最高的四分位数与1.60倍的血压升高风险（95%置信区间，1.19至2.14）和1.61倍的高血压风险（95%置信区间，1.05至2.46）相关。血清醛固酮水平与血压结果之间的关联不受尿钠排泄量、左心室厚度或内部尺寸调整的显著影响。结论：在我们以社区为基础的样本中，生理范围内醛固酮水平升高易使人患高血压。
Background: Primary hyperaldosteronism is a well-recognized cause of secondary hypertension. It is unknown whether serum aldosterone levels within the physiologic range influence the risk of hypertension.Methods: We investigated the relation of baseline serum aldosterone levels to increases in blood pressure and the incidence of hypertension after four years in 1688 nonhypertensive participants in the Framingham Offspring Study (mean age, 55 years), 58 percent of whom were women. We defined an increase in blood pressure as an increment of at least one blood-pressure category (as defined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) and defined hypertension as a systolic blood pressure of 140 mm Hg or higher, a diastolic blood pressure of 90 mm Hg or higher, or the use of antihypertensive medications.Results: At follow-up, the blood-pressure category had increased in 33.6 percent of the participants, and hypertension had developed in 14.8 percent. In multivariable models, a 16 percent increase in the risk of an elevation in blood pressure (P=0.002) and a 17 percent increase in the risk of hypertension (P=0.03) were observed per quartile increment in the serum aldosterone level. The highest serum aldosterone quartile, relative to the lowest, was associated with a 1.60-fold risk of an elevation in blood pressure (95 percent confidence interval, 1.19 to 2.14) and a 1.61-fold risk of hypertension (95 percent confidence interval, 1.05 to 2.46). The associations between the serum aldosterone level and blood-pressure outcomes were not significantly affected by adjustment for urinary sodium excretion or left ventricular thickness or internal dimensions.Conclusions: In our community-based sample, increased aldosterone levels within the physiologic range predisposed persons to the development of hypertension.