title: Association of elevated plasma aldosterone-to-renin ratio with future cardiovascular events in patients with essential hypertension.
abstract: BACKGROUND
  We investigated the relationship between the renin/aldosterone profiles of patients with essential hypertension and their prognosis using a long-term follow-up study design.
  
  
  METHODS
  The cohort consisted of 125 Japanese patients with essential hypertension whose plasma-renin activity (PRA) (ng/ml per h), plasma-aldosterone concentration (PAC) (ng/dl), and ratio of PAC to PRA [aldosterone-renin ratio (ARR)] were determined under hospitalization from 1984 to 1993. The patients were divided into two groups according to their ARRs relative to the 50th percentile of the ARR value (ARR = 5.5); the low-ARR group (ARR <5.5, n = 66) and high-ARR group (ARR > 5.5, n = 59). Their clinical outcomes were monitored during follow-up by the attending physicians.
  
  
  RESULTS
  Ninety-six patients with essential hypertension (77% of the original cohort) were eligible for the analyses. The mean follow-up time was 18.6 ± 5.2 years. The cardiovascular morbidity was significantly higher in the high-ARR group than in the low-ARR group 3.2 vs. 2.4 per 100 patient-years, respectively (P = 0.014 by Kaplan-Meier analysis). Among the cardiovascular events, the incidence of stroke was 2.7-fold higher in the high-ARR group than in the low-ARR group. High ARR was an independent risk marker for cardiovascular events by Cox proportional hazards model analysis.
  
  
  CONCLUSIONS
  : High ARR was an independent risk marker for cardiovascular events in patients with essential hypertension.
authors.affiliation: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Kisaka
authors.forename: Ryoji
authors.initials: R
authors.lastname: Ozono
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ishida
authors.forename: Yukihito
authors.initials: Y
authors.lastname: Higashi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Oshima
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kihara
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D044466:Asian People; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D015331:Cohort Studies; D000075222:Essential Hypertension; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000150:complications* / Q000208:ethnology; D015994:Incidence; D007564:Japan; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012083:Renin / Q000097:blood*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000208:ethnology
chemical_list: D000450:Aldosterone; D012083:Renin