Published online before print February 12, 2007, doi: 10.1161/01.HYP.0000258554.87444.91
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(Hypertension. 2007;49:846.)
© 2007 American Heart Association, Inc.
Original Articles |
Clinical and Genetic Correlates of Aldosterone-to-Renin Ratio and Relations to Blood Pressure in a Community Sample
From the Framingham Heart Study of the National Heart Lung and Blood Institute and Boston University School of Medicine (C.N.-C., C.-Y.G., P.G., M.G.L., E.J.B., T.J.W., S.K., C.J.O., D.L., R.S.V.), Framingham, Mass; the Broad Institute of Harvard and Massachusetts Institute of Technology (C.N.-C., S.K., S.L.M., A.L.C., J.A.D., J.N.H.), Cambridge; the Cardiology Division (C.N.-C., T.J.W., S.K., C.O.D.), Massachusetts General Hospital, Boston; the Department of Mathematics and Statistics (C.-Y.G., P.G., M.G.L.), Boston University, Mass; the Section of Epidemiology and Preventive Medicine (M.G.L.) and the Evans Department of Medicine and Whitaker Cardiovascular Institute (E.J.B., R.S.V.), Boston University School of Medicine, Mass; the Department of Medicine (D.L.), Beth-Israel Deaconess Medical Center, Boston, Mass; the National Heart Lung and Blood Institute (C.J.O., D.L.), Bethesda, Md; and the Children’s Hospital of Boston, Massachusetts (J.D., J.N.H.).
Correspondence to Christopher Newton-Cheh, Framingham Heart Study, 73 Mt Wayte Avenue, Suite #2, Framingham, MA 01702-5827. E-mail cnewtoncheh{at}partners.org
Aldosterone:renin ratio (ARR) is used to screen for hyperaldosteronism. Data regarding correlates of ambulatory ARR in the community and its relation to hypertension incidence are limited. We defined clinical correlates of ARR, determined its heritability, tested for association and linkage, and related ARR to blood pressure (BP) progression in nonhypertensive individuals among 3326 individuals from the Framingham Heart Study (53% women; mean age: 59 years). Ambulatory morning ARR (serum aldosterone and plasma renin concentrations) were related to clinical covariates, genetic variation across the REN locus, a 10-cM linkage map, and among nonhypertensive participants (n=1773) to progression of 
1 Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure BP category (optimal: <120/80 mm Hg, normal: 120 to 129/80 to 84 mm Hg, high normal: 130 to 139/85 to 89 mm Hg, hypertension: 140/90 mm Hg), or incident hypertension (systolic BP: 140 mm Hg, diastolic BP: 90 mm Hg, or use of antihypertensive treatment). ARR was positively associated with age, female sex, untreated hypertension, total/high-density lipoprotein cholesterol ratio, hormone replacement therapy, and ß-blocker use, but negatively associated with angiotensin-converting enzyme inhibitor and diuretic use. ARR was heritable (h2=0.40), had modest linkage to chromosome 11p (logarithm of the odds: 1.89), but was not associated with 17 common variants in REN (n=1729). On follow-up (mean: 3 years), 607 nonhypertensive individuals (34.2%) developed BP progression, and 283 (16.0%) developed hypertension. Higher baseline logARR was associated with increased risk of BP progression (odds ratio per SD increment: 1.23; 95% CI: 1.11 to 1.37) and hypertension incidence (odds ratio per SD increment: 1.16; 95% CI: 1.00 to 1.33). ARR is a heritable trait influenced by clinical and genetic factors. There is a continuous gradient of increasing risk of BP progression across ARR levels in nonhypertensive individuals.
Key Words: aldosterone • renin • hypertension, essential • blood pressure • genetics • population • risk factors
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