Aldosterone/renin ratio determines peripheral and central blood pressure values over a broad range.
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.
Tomaschitz
Andreas
A
Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Maerz
Winfried
W
Pilz
Stefan
S
Ritz
Eberhard
E
Scharnagl
Hubert
H
Renner
Wilfried
W
Boehm
Bernhard O
BO
Fahrleitner-Pammer
Astrid
A
Weihrauch
Gisela
G
Dobnig
Harald
H
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
D015415:Biomarkers; D000450:Aldosterone; D012083:Renin