title: Aldosterone/renin ratio determines peripheral and central blood pressure values over a broad range.
abstract: OBJECTIVE
  With the present analysis we intended to investigate the magnitude of the effect of relative aldosterone excess in predicting peripheral as well as aortic blood pressure levels in a well-characterized cohort of patients undergoing coronary angiography.
  
  
  BACKGROUND
  The discussion on the relationship between aldosterone concentration and blood pressure has recently gone beyond the role of primary aldosteronism in the genesis of arterial hypertension.
  
  
  METHODS
  Plasma aldosterone (pg/ml) and plasma renin concentration (pg/ml) were determined in 3,056 Caucasian patients (age 62.5 +/- 11 years; 31.9% women) scheduled for coronary angiography in a single tertiary care center. We formed sex-specific deciles (D) according to plasma aldosterone/renin concentration ratio (ARR) (pg/ml/pg/ml).
  
  
  RESULTS
  Mean peripheral systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the entire cohort were 141 +/- 24 mm Hg and 81 +/- 11 mm Hg, respectively. Mean ARR was 10.2 +/- 15.7 in men and 14.4 +/- 19.9 in women (p < 0.0001). Median SBP and aortic SBP increased steadily and significantly from ARR D1 (126.8 mm Hg and 130.0 mm Hg, respectively) to D10 (151.0 mm Hg and 149.6 mm Hg, respectively; p < 0.0001 for both) after multivariate adjustment for age, sex, body mass index, renal function, antihypertensive medications, and various parameters potentially influencing BP. Adjusted median DBP and aortic DBP also increased significantly from 74.3 mm Hg and 66.5 mm Hg (D1) to 86.9 mm Hg and 76.7 mm Hg, respectively (D10) (p < 0.001 for both). In a multivariate stepwise regression model, ARR emerged as the second most significant independent predictor (after age) of mean SBP and as the most important predictor of mean DBP in this patient cohort.
  
  
  CONCLUSIONS
  Our results: 1) underline that the ARR affects BP well below a cutoff used for screening for primary aldosteronism; and 2) illustrate the importance of the ARR in modulating BP over a much wider range than is currently appreciated.
authors.affiliation: Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Tomaschitz
authors.forename: Winfried
authors.initials: W
authors.lastname: Maerz
authors.forename: Stefan
authors.initials: S
authors.lastname: Pilz
authors.forename: Eberhard
authors.initials: E
authors.lastname: Ritz
authors.forename: Hubert
authors.initials: H
authors.lastname: Scharnagl
authors.forename: Wilfried
authors.initials: W
authors.lastname: Renner
authors.forename: Bernhard O
authors.initials: BO
authors.lastname: Boehm
authors.forename: Astrid
authors.initials: A
authors.lastname: Fahrleitner-Pammer
authors.forename: Gisela
authors.initials: G
authors.lastname: Weihrauch
authors.forename: Harald
authors.initials: H
authors.lastname: Dobnig
mesh_terms: D000450:Aldosterone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D017023:Coronary Angiography; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006973:Hypertension / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012083:Renin / Q000097:blood*; D012084:Renin-Angiotensin System / Q000502:physiology*; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D000450:Aldosterone; D012083:Renin