Aldosterone-to-renin ratio is related to arterial stiffness when the screening criteria of primary aldosteronism are not met

Abstract

Aldosterone-to-renin ratio (ARR) is a screening tool for primary aldosteronism (PA), but the significance of ARR when the PA criteria are not met remains largely unknown. In this cross-sectional study we investigated the association of ARR with haemodynamic variables in 545 normotensive and never-medicated hypertensive subjects (267 men, 278 women, age range 19-72 years) without suspicion of PA. Supine haemodynamic data was recorded using whole-body impedance cardiography and radial tonometric pulse wave analysis. In sex-adjusted quartiles of ARR, determined as serum aldosterone to plasma renin activity ratio, the mean values were 282, 504, 744 and 1467 pmol/µg of angiotensin I/h, respectively. The only difference in haemodynamic variables between the ARR quartiles was higher pulse wave velocity (PWV) in the highest quartile versus other quartiles (p = 0.004), while no differences in blood pressure (BP), heart rate, wave reflections, cardiac output or systemic vascular resistance were observed between the quartiles. In linear regression analysis with stepwise elimination, ARR was an independent explanatory factor for PWV (β = 0.146, p < 0.001, R² of the model 0.634). In conclusion, ARR was directly and independently associated with large arterial stiffness in individuals without clinical suspicion of PA. Therefore, ARR could serve as a clinical marker of cardiovascular risk.Trial registration: ClinicalTrails.gov: NCT01742702.

Figure 1

Radial systolic (a) and diastolic (b) blood pressure calibrated from brachial blood pressure measurements, and aortic systolic (c) and diastolic (d) blood pressure in quartiles (n = 135–137) of aldosterone-to-renin ratio (ARR); analyses were adjusted for sex, age, and estimated glomerular filtration rate; ANOVA-RM, analysis of variance for repeated measurements, results are depicted as mean and standard error of the mean.

Figure 2

Heart rate (a), stroke index (b), cardiac index (c) and systemic vascular resistance index (d) in quartiles (n = 135–137) of aldosterone-to-renin ratio (ARR); analyses were adjusted for sex, age, and estimated glomerular filtration rate; ANOVA-RM, analysis of variance for repeated measurements, mean and standard error of the mean.

Figure 3

Forward wave amplitude (a), augmentation index (b), extracellular water balance (c) and aortic-to-popliteal pulse wave velocity (d) in quartiles (n = 135–137) of aldosterone-to-renin ratio (ARR); analyses were adjusted for sex, age, and estimated glomerular filtration rate; ANOVA-RM, analysis of variance for repeated measurements, mean and standard error of the mean.