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FOCUS ISSUE: BIOMARKERS IN CARDIOVASCULAR DISEASE: CLINICAL RESEARCH: BIOMARKERS IN VASCULAR DISEASE AND HYPERTENSION

Aldosterone/Renin Ratio Determines Peripheral and Central Blood Pressure Values Over a Broad Range

Andreas Tomaschitz, MD^_*, Winfried Maerz, MD^,||, Stefan Pilz, MD^_*, Eberhard Ritz, MD, Hubert Scharnagl, PhD, Wilfried Renner, PhD, Bernhard O. Boehm, MD, Astrid Fahrleitner-Pammer, MD^_*, Gisela Weihrauch, MSc and Harald Dobnig, MD^_*,_*

^_* Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
Department of Internal Medicine, Heidelberg University, Heidelberg, Germany
Division of Endocrinology and Diabetes, Department of Internal Medicine, University of Ulm, Ulm, Germany
^|| Synlab Center of Laboratory Diagnostics Heidelberg, Eppelheim, Germany

Manuscript received July 14, 2009; revised manuscript received October 30, 2009, accepted January 6, 2010.

^_* Reprint requests and correspondence: Dr. Harald Dobnig, Professor of Internal Medicine, Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria (Email: harald.dobnig{at}medunigraz.at).

Objectives: 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.

Key Words: aldosterone • aldosterone/renin ratio • arterial blood pressure • hypertension • pathophysiology • renin

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ANOVA = analysis of variance   ARB = angiotensin-2 receptor blocker   ARR = aldosterone/renin concentration ratio   BP = blood pressure   DBP = diastolic blood pressure   NT-pBNP = N-terminal pro-brain natriuretic peptide   PAC = plasma aldosterone concentration   PRC = plasma renin concentration   QU = quartile   SBP = systolic blood pressure

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