Aldosterone-to-renin ratio as a predictor of stroke under conditions of high sodium intake: The ohasama study

Michihiro Satoh, Masahiro Kikuya, Takayoshi Ohkubo, Takefumi Mori, Hirohito Metoki, Azusa Hara, Megumi T. Utsugi, Takanao Hashimoto, Takuo Hirose, Taku Obara, Ryusuke Inoue, Kei Asayama, Atsuhiro Kanno, Kazuhito Totsune, Haruhisa Hoshi, Hiroshi Satoh, Yutaka Imai

Research output: Contribution to journalArticle

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Abstract

Background Aldosterone is thought to have deleterious effects on the cardiovascular system. The aldosterone-to-renin ratio (ARR) is more reproducible than aldosterone levels alone and could be an index for inappropriate aldosterone secretion or activity. We previously reported the apparent relation between ARR and hypertension in subjects with high sodium intake. This prospective study investigated the risk of ARR for a first stroke in a general population stratified by sodium intake.MethodsWe obtained plasma renin activity (PRA) and plasma aldosterone concentrations (PAC) for 883 participants aged 35 years not receiving antihypertensive treatment in the general population of Ohasama (mean age: 59.0 1±1.3 years; 65.6% women).ResultsOver a mean of 10.9 follow-up years, 45 strokes occurred. The median PRA, PAC, and ARR were 1.2 ng/ml/h, 6.4 ng/dl, and 5.3 ng/dl per ng/ml/h, respectively. Using Cox regression, we computed hazard ratios adjusted for sex, age, body mass index (BMI), and systolic blood pressure. No association between logARR and stroke was observed in subjects overall. However, in subjects with high sodium intake (median of 4,058 mg/day (salt equivalent, 10.5 g/day)), each 1 s.d. increase in logARR was associated with an increased hazard ratio for stroke (hazard ratio: 1.49, P = 0.04). No significant association was observed in subjects with low sodium intake (P = 0.7). When we repeated all the analyses using logPRA or logPAC, no significant associations were found.ConclusionThese results suggest that high ARR, that is, relative aldosterone excess, is a predictor for stroke under conditions of high sodium intake.

Original languageEnglish
Pages (from-to)777-783
Number of pages7
JournalAmerican journal of hypertension
Volume25
Issue number7
DOIs
Publication statusPublished - 2012 Jul 1
Externally publishedYes

Fingerprint

Aldosterone
Renin
Sodium
Stroke
Blood Pressure
Sex Ratio
Cardiovascular System
Antihypertensive Agents
Population
Body Mass Index
Salts
Prospective Studies
Hypertension

Keywords

  • aldosterone-to-renin ratio
  • blood pressure
  • hypertension
  • relative aldosterone excess
  • salt-sensitive hypertension
  • sodium intake
  • stroke

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Aldosterone-to-renin ratio as a predictor of stroke under conditions of high sodium intake : The ohasama study. / Satoh, Michihiro; Kikuya, Masahiro; Ohkubo, Takayoshi; Mori, Takefumi; Metoki, Hirohito; Hara, Azusa; Utsugi, Megumi T.; Hashimoto, Takanao; Hirose, Takuo; Obara, Taku; Inoue, Ryusuke; Asayama, Kei; Kanno, Atsuhiro; Totsune, Kazuhito; Hoshi, Haruhisa; Satoh, Hiroshi; Imai, Yutaka.

In: American journal of hypertension, Vol. 25, No. 7, 01.07.2012, p. 777-783.

Research output: Contribution to journalArticle

Satoh, M, Kikuya, M, Ohkubo, T, Mori, T, Metoki, H, Hara, A, Utsugi, MT, Hashimoto, T, Hirose, T, Obara, T, Inoue, R, Asayama, K, Kanno, A, Totsune, K, Hoshi, H, Satoh, H & Imai, Y 2012, 'Aldosterone-to-renin ratio as a predictor of stroke under conditions of high sodium intake: The ohasama study', American journal of hypertension, vol. 25, no. 7, pp. 777-783. https://doi.org/10.1038/ajh.2012.33
Satoh, Michihiro ; Kikuya, Masahiro ; Ohkubo, Takayoshi ; Mori, Takefumi ; Metoki, Hirohito ; Hara, Azusa ; Utsugi, Megumi T. ; Hashimoto, Takanao ; Hirose, Takuo ; Obara, Taku ; Inoue, Ryusuke ; Asayama, Kei ; Kanno, Atsuhiro ; Totsune, Kazuhito ; Hoshi, Haruhisa ; Satoh, Hiroshi ; Imai, Yutaka. / Aldosterone-to-renin ratio as a predictor of stroke under conditions of high sodium intake : The ohasama study. In: American journal of hypertension. 2012 ; Vol. 25, No. 7. pp. 777-783.
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abstract = "Background Aldosterone is thought to have deleterious effects on the cardiovascular system. The aldosterone-to-renin ratio (ARR) is more reproducible than aldosterone levels alone and could be an index for inappropriate aldosterone secretion or activity. We previously reported the apparent relation between ARR and hypertension in subjects with high sodium intake. This prospective study investigated the risk of ARR for a first stroke in a general population stratified by sodium intake.MethodsWe obtained plasma renin activity (PRA) and plasma aldosterone concentrations (PAC) for 883 participants aged 35 years not receiving antihypertensive treatment in the general population of Ohasama (mean age: 59.0 1±1.3 years; 65.6{\%} women).ResultsOver a mean of 10.9 follow-up years, 45 strokes occurred. The median PRA, PAC, and ARR were 1.2 ng/ml/h, 6.4 ng/dl, and 5.3 ng/dl per ng/ml/h, respectively. Using Cox regression, we computed hazard ratios adjusted for sex, age, body mass index (BMI), and systolic blood pressure. No association between logARR and stroke was observed in subjects overall. However, in subjects with high sodium intake (median of 4,058 mg/day (salt equivalent, 10.5 g/day)), each 1 s.d. increase in logARR was associated with an increased hazard ratio for stroke (hazard ratio: 1.49, P = 0.04). No significant association was observed in subjects with low sodium intake (P = 0.7). When we repeated all the analyses using logPRA or logPAC, no significant associations were found.ConclusionThese results suggest that high ARR, that is, relative aldosterone excess, is a predictor for stroke under conditions of high sodium intake.",
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AU - Satoh, Michihiro

AU - Kikuya, Masahiro

AU - Ohkubo, Takayoshi

AU - Mori, Takefumi

AU - Metoki, Hirohito

AU - Hara, Azusa

AU - Utsugi, Megumi T.

AU - Hashimoto, Takanao

AU - Hirose, Takuo

AU - Obara, Taku

AU - Inoue, Ryusuke

AU - Asayama, Kei

AU - Kanno, Atsuhiro

AU - Totsune, Kazuhito

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AU - Imai, Yutaka

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N2 - Background Aldosterone is thought to have deleterious effects on the cardiovascular system. The aldosterone-to-renin ratio (ARR) is more reproducible than aldosterone levels alone and could be an index for inappropriate aldosterone secretion or activity. We previously reported the apparent relation between ARR and hypertension in subjects with high sodium intake. This prospective study investigated the risk of ARR for a first stroke in a general population stratified by sodium intake.MethodsWe obtained plasma renin activity (PRA) and plasma aldosterone concentrations (PAC) for 883 participants aged 35 years not receiving antihypertensive treatment in the general population of Ohasama (mean age: 59.0 1±1.3 years; 65.6% women).ResultsOver a mean of 10.9 follow-up years, 45 strokes occurred. The median PRA, PAC, and ARR were 1.2 ng/ml/h, 6.4 ng/dl, and 5.3 ng/dl per ng/ml/h, respectively. Using Cox regression, we computed hazard ratios adjusted for sex, age, body mass index (BMI), and systolic blood pressure. No association between logARR and stroke was observed in subjects overall. However, in subjects with high sodium intake (median of 4,058 mg/day (salt equivalent, 10.5 g/day)), each 1 s.d. increase in logARR was associated with an increased hazard ratio for stroke (hazard ratio: 1.49, P = 0.04). No significant association was observed in subjects with low sodium intake (P = 0.7). When we repeated all the analyses using logPRA or logPAC, no significant associations were found.ConclusionThese results suggest that high ARR, that is, relative aldosterone excess, is a predictor for stroke under conditions of high sodium intake.

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KW - salt-sensitive hypertension

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