Serum aldosterone and the incidence of hypertension in nonhypertensive persons.
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.
Vasan
Ramachandran S
RS
National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, Mass 01702-5827, USA. vasan@bu.edu
Evans
Jane C
JC
Larson
Martin G
MG
Wilson
Peter W F
PW
Meigs
James B
JB
Rifai
Nader
N
Benjamin
Emelia J
EJ
Levy
Daniel
D
D000450:Aldosterone / Q000097:blood*; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006352:Heart Ventricles / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications*; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012964:Sodium / Q000652:urine; D014463:Ultrasonography
D000450:Aldosterone; D012964:Sodium