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Association of elevated plasma aldosterone-to-renin ratio with future cardiovascular events in patients with essential hypertension

Kisaka, Tomohikoa; Ozono, Ryojib; Ishida, Takafumia; Higashi, Yukihitoa; Oshima, Tetsuyaa; Kihara, Yasukia

doi: 10.1097/HJH.0b013e328359862d

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.

Conclusion: High ARR was an independent risk marker for cardiovascular events in patients with essential hypertension.

aDepartments of Cardiovascular Medicine

bGeneral Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan

Correspondence to Ryoji Ozono, MD, PhD, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Tel: +81 82 257 5552; fax: +81 82 257 5554; e-mail:

Abbreviations: ARR, aldosterone–renin ratio; ASO, arteriosclerosis obliterans; CHF, congestive heart failure; CI, confidence intervals; LVH, left ventricular hypertrophy; MABP, mean arterial blood pressure; PAC, plasma–aldosterone concentration; PRA, plasma–renin activity; Q25, Q75, indicate lower, upper quartiles; RAAS, renin–angiotensin–aldosterone system; RR, relative risk; SHR-SP, stroke-prone spontaneously hypertensive rats

Received 6 November, 2011

Revised 3 August, 2012

Accepted 20 August, 2012

© 2012 Lippincott Williams & Wilkins, Inc.