title: Association of aldosterone-to-renin ratio with hypertension differs by sodium intake: the Ohasama study.
abstract: BACKGROUND
  In cross-sectional studies, the aldosterone-to-renin ratio (ARR) has been reported to be associated with hypertension under conditions of higher sodium intake. The objective of this prospective study was to investigate the association between ARR and the development of hypertension in community residents stratified by dietary sodium intake.
  
  
  METHODS
  From the general population of Ohasama, we obtained plasma renin activity (PRA) and plasma aldosterone concentrations (PACs) for 608 participants (mean age = 57.6 years; 71.4% women) without hypertension at baseline. Using the Cox model, we computed the adjusted hazard ratio (HR) of natural log-transformed ARR (lnARR) for the development of hypertension, defined as blood pressure ≥140/90mm Hg or start of treatment with antihypertensive drugs during follow-up.
  
  
  RESULTS
  During a mean follow-up of 6.8 years, 298 participants developed hypertension. The median PRA, PAC, and ARR were 1.2ng/ml/hour, 6.6ng/dl, and 5.5ng/dl per ng/ml/hour, respectively. Each 1 SD increase in lnARR was associated with an increased risk for the development of hypertension in participants overall (HR = 1.18; P = 0.007). In participants with higher sodium intake (median ≥4,102mg/day), a significant association of lnARR with hypertension remained (HR = 1.25; P = 0.009), whereas no significant association was observed in participants with lower sodium intake (P = 0.18). Participants who developed hypertension had significantly lower PRA than those who did not (P = 0.003), despite no differences in PAC (P = 0.91).
  
  
  CONCLUSIONS
  These results raise the hypothesis that relative aldosterone excess may have a deleterious effect on the development of hypertension by contributing to salt/volume-related hypertension.
authors: Department of Pharmacy, Tohoku University Hospital, Sendai, Japan; satoh.mchr@hosp.tohoku.ac.jp.
authors: Michihiro
authors: M
authors: Satoh
authors: Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan;
authors: Masahiro
authors: M
authors: Kikuya
authors: Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan;
authors: Miki
authors: M
authors: Hosaka
authors: Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan; Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan;
authors: Kei
authors: K
authors: Asayama
authors: Department of Medical Information Technology Center, Tohoku University Hospital, Sendai, Japan;
authors: Ryusuke
authors: R
authors: Inoue
authors: Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan;
authors: Hirohito
authors: H
authors: Metoki
authors: National Institute of Health and Nutrition, Tokyo, Japan;
authors: Megumi
authors: M
authors: Tsubota-Utsugi
authors: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium;
authors: Azusa
authors: A
authors: Hara
authors: Early Development and Pathologies, Center for Interdisciplinary Research in Biology, College de France, Paris, France;
authors: Takuo
authors: T
authors: Hirose
authors: Department of Pharmacy, Tohoku University Hospital, Sendai, Japan; Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan;
authors: Taku
authors: T
authors: Obara
authors: Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan;
authors: Takefumi
authors: T
authors: Mori
authors: Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan; Department of Social Welfare, Tohoku Fukushi University, Sendai, Japan;
authors: Kazuhito
authors: K
authors: Totsune
authors: Ohasama Hospital, Iwate, Japan.
authors: Haruhisa
authors: H
authors: Hoshi
authors: Department of Pharmacy, Tohoku University Hospital, Sendai, Japan;
authors: Nariyasu
authors: N
authors: Mano
authors: Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan;
authors: Yutaka
authors: Y
authors: Imai
authors: Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan;
authors: Takayoshi
authors: T
authors: Ohkubo
mesh_terms: D000368:Aged; D000450:Aldosterone / Q000097:blood*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000453:epidemiology*; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012083:Renin / Q000097:blood*; D012982:Sodium, Dietary
chemical_list: D012982:Sodium, Dietary; D000450:Aldosterone; D012083:Renin
keywords: aldosterone; blood pressure; epidemiology; hypertension; relative aldosterone excess; renin; salt intake.