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Thomas M. Macdonald - One of the best experts on this subject based on the ideXlab platform.

  • Primary aldosteronism, diagnosed by the aldosterone to renin Ratio, is a common cause of hypertension.
    Clinical endocrinology, 2003
    Co-Authors: Pitt O. Lim, Thomas M. Macdonald
    Abstract:

    ., 2002). Importantly,it has been clearly shown that controlling BP offers significantbenefits. A 5-mmHg reduction in the population diastolic BP over5 years is associated with a reduction in strokes of about 40%and cardiac events by about a quarter, highlighting the need foradequate BP control (Collins

  • Variation at the aldosterone synthase (CYP11B2) locus contributes to hypertension in subjects with a raised Aldosterone-to-Renin Ratio
    The Journal of clinical endocrinology and metabolism, 2002
    Co-Authors: Pitt O. Lim, Thomas M. Macdonald, Christine D. Holloway, Elaine C. Friel, Niall H. Anderson, Eleanor Dow, Roland T. Jung, Eleanor Davies, Robert Fraser, John M. C. Connell
    Abstract:

    The Aldosterone-to-Renin Ratio (ARR) is a marker of aldosterone activity in hypertension. We examined the relationship of the ARR to the distribution of two biallelic polymorphisms at the CYP11B2 gene locus. One polymorphism affects a putative steroidogenic factor-1 binding site (−344 T/C) in the 5′-regulatory region, whereas the other marker reflects replacement of the intron-2 from CYP11B2 with that from the neighboring gene encoding 11β-hydroxylase (CYP11B1; wild-type/conversion). We studied consecutive referrals to the Tayside hypertension clinic in 1998. Because the specificity of ARR (pmol/liter/ng/ml/h) for hyperaldosteronism increases with its threshold, ARRs of at least 750 and 1000 were used. A total of 375 patients were assessed; 86.9% had complete data. There were significant excesses of steroidogenic factor-1 (T) (ARR ≥ 750, 0.62 vs. 0.51, P = 0.014; ARR ≥ 1000, 0.63 vs. 0.51, P = 0.039) and intron-2 (conversion) (ARR ≥ 750, 0.49 vs. 0.41, P = 0.205; ARR ≥ 1000, 0.54 vs. 0.41, P = 0.029) alle...

  • The neurohormonal natural history of essential hypertension: towards primary or tertiary aldosteronism?
    Journal of hypertension, 2002
    Co-Authors: Pitt O. Lim, Allan D. Struthers, Thomas M. Macdonald
    Abstract:

    Use of the Aldosterone-to-Renin Ratio has controversially suggested that approximately 10% of hypertensives have primary aldosteronism, and most of these individuals are thought to have idiopathic hyperaldosteronism. The usual renin–angiotensin system control is intact in these individuals and is si

  • Aldosterone to renin Ratio as a determinant of exercise blood pressure response in hypertensive patients.
    Journal of human hypertension, 2001
    Co-Authors: Pitt O. Lim, Peter T. Donnan, Thomas M. Macdonald
    Abstract:

    Aldosterone to renin Ratio (ARR) is a marker of inappropriate aldosterone activity in hypertension. Since aldosterone may adversely affect vascular compliance, we hypothesised that the ARR would relate to exercise blood pressure (BP) responses in hypertension. Blood sampling was done in untreated hypertensives for plasma renin activity (PRA, ng/mL/hr) and plasma aldosterone (PA, pmol/L). ARR was derived by dividing the PA value by the PRA value, and this index was normalised by natural logarithm (lnARR) for further analyses. Each patient underwent 24-h ambulatory BP (ABP), and a 3-min submaximal exercise test using the Dundee Step Test. The Spearman rank correlation coefficients between lnARR and office BP (OBP), ABP and exercise BPs and BP changes estimated during exercise were assessed. A total of 119 (66 males) hypertensive subjects aged 48 (s.d. 12) years were studied. The respective OBP, ABP, exercise BP and the change in exercise BP were 167(23)/105(11), 140(15)/87(10), 189(26)/107(12) and 25(15)/2(9) mmHg. lnARR was significantly correlated with exercise systolic BP (r = 0.24, P < 0.001), exercise diastolic bp (r = 0.23, P < 0.05), systolic abp (r = 0.22, P < 0.05) and systolic obp (r = 0.19, P < 0.05). in a multiple regressional analysis controlling for age and sex and all other bp measurements to assess the relative strengths of correlation between all the bp indices with lnarr, only exercise systolic bp (P = 0.012) and the change in systolic BP during exercise (negatively, P = 0.013) emerged as significant independent predictors of lnARR. In conclusion, there was an independent and significant correlation between ARR and exercise systolic BP.

  • A review of the medical treatment of primary aldosteronism
    Journal of hypertension, 2001
    Co-Authors: Pitt O. Lim, William F. Young, Thomas M. Macdonald
    Abstract:

    PurposeUse of the Aldosterone-to-Renin Ratio (ARR) has suggested that at least one in 10 hypertensive subjects have primary aldosteronism (PA). There is thus a timely need to review the literature for effective drug therapies and to speculate on other therapeutic options by taking into account recen

Taku Obara - One of the best experts on this subject based on the ideXlab platform.

  • Association of Aldosterone-to-Renin Ratio With Hypertension Differs by Sodium Intake: The Ohasama Study
    American journal of hypertension, 2014
    Co-Authors: Michihiro Satoh, Masahiro Kikuya, Azusa Hara, Takuo Hirose, Hirohito Metoki, Ryusuke Inoue, Miki Hosaka, Kei Asayama, Megumi Tsubota-utsugi, Taku Obara
    Abstract:

    background In cross-sectional studies, the Aldosterone-to-Renin Ratio (ARR) has been reported to be associated with hypertension under conditions of higher sodium intake. The objective of this prospective study was to investigate the association between ARR and the development of hypertension in community residents stratified by dietary sodium intake. methods From the general population of Ohasama, we obtained plasma renin activity (PRA) and plasma aldosterone concentRations (PACs) for 608 participants (mean age = 57.6 years; 71.4% women) without hypertension at baseline. Using the Cox model, we computed the adjusted hazard Ratio (HR) of natural log-transformed ARR (lnARR) for the development of hypertension, defined as blood pressure ≥140/90 mm Hg or start of treatment with antihypertensive drugs during follow-up. results During a mean follow-up of 6.8 years, 298 participants developed hypertension. The median PRA, PAC, and ARR were 1.2 ng/ml/hour, 6.6 ng/dl, and 5.5 ng/dl per ng/ml/hour, respectively. Each 1 SD increase in lnARR was associated with an increased risk for the development of hypertension in participants overall (HR = 1.18; P = 0.007). In participants with higher sodium intake (median ≥4,102 mg/day), a significant association of lnARR with hypertension remained (HR = 1.25; P = 0.009), whereas no significant association was observed in participants with lower sodium intake (P = 0.18). Participants who developed hypertension had significantly lower PRA than those who did not ( P = 0.003), despite no differences in PAC ( P = 0.91).

  • Aldosterone-to-Renin Ratio and nocturnal blood pressure decline assessed by self-measurement of blood pressure at home: the Ohasama Study.
    Clinical and experimental hypertension (New York N.Y. : 1993), 2014
    Co-Authors: Michihiro Satoh, Masahiro Kikuya, Azusa Hara, Takuo Hirose, Hirohito Metoki, Ryusuke Inoue, Miki Hosaka, Kei Asayama, Megumi Utsugi, Taku Obara
    Abstract:

    AbstractBased on ambulatory blood pressure (BP) monitoring, the Aldosterone-to-Renin Ratio (ARR) has been reported to be associated with a diminished nocturnal decline in BP, generally referred to as a “non-dipping” pattern. The objective of this cross-sectional study was to investigate the association between ARR and the non-dipping pattern based on home BP measurements. This study included 177 participants ≥55 years from the general population of Ohasama (mean age: 67.2 years; 74.6% women); no patient was receiving antihypertensive treatment. The median plasma renin activity (PRA), plasma aldosterone concentRation (PAC) and ARR were 0.8 ng/mL/h, 8.1 ng/dL and 9.7 ng/dL per ng/mL/h, respectively. Each 1 SD increase in log-transformed (ln) ARR was significantly associated with the prevalence of the non-dipping pattern after adjustments for possible confounding factors including home morning systolic BP (odds Ratio, 1.45; p = 0.049). However, no significant associations of PRA or PAC with the non-dipping p...

  • Aldosterone-to-Renin Ratio as a Predictor of Stroke Under Conditions of High Sodium Intake: The Ohasama Study
    American journal of hypertension, 2012
    Co-Authors: Michihiro Satoh, Masahiro Kikuya, Takayoshi Ohkubo, Takanao Hashimoto, Azusa Hara, Takuo Hirose, Hirohito Metoki, Megumi Utsugi, Takefumi Mori, Taku Obara
    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. METHODS We 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 ± 11.3 years; 65.6% women). RESULTS Over 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. CONCLUSION These results suggest that high ARR, that is, relative aldosterone excess, is a predictor for stroke under conditions of high sodium intake.

  • Plasma renin activity and the Aldosterone-to-Renin Ratio are associated with the development of chronic kidney disease: the Ohasama Study.
    Journal of hypertension, 2012
    Co-Authors: Shiho Terata, Masahiro Kikuya, Michihiro Satoh, Takayoshi Ohkubo, Takanao Hashimoto, Azusa Hara, Takuo Hirose, Taku Obara, Hirohito Metoki, Ryusuke Inoue
    Abstract:

    Background:The Aldosterone-to-Renin Ratio (ARR) is used to screen for primary aldosteronism and could be an index for salt sensitivity. The association between ARR and the development of chronic kidney disease (CKD) is completely unknown.Method:A longitudinal observational study involving 689 partic

  • Aldosterone-to-Renin Ratio and nocturnal blood pressure decline in a general population: the Ohasama study.
    Journal of hypertension, 2011
    Co-Authors: Michihiro Satoh, Masahiro Kikuya, Takayoshi Ohkubo, Takanao Hashimoto, Azusa Hara, Takuo Hirose, Hirohito Metoki, Megumi Utsugi, Takefumi Mori, Taku Obara
    Abstract:

    BackgroundAldosterone-to-Renin Ratio (ARR) is an index for inappropriate aldosterone activity and salt sensitivity. We previously reported that elevated ARR might be associated with salt-sensitive hypertension. Because salt-sensitive hypertensive patients are reported to show a diminished nocturnal

Oliviero Olivieri - One of the best experts on this subject based on the ideXlab platform.

  • Urinary prostasin in normotensive individuals : correlation with the aldosterone to renin Ratio and urinary sodium
    Hypertension research : official journal of the Japanese Society of Hypertension, 2013
    Co-Authors: Oliviero Olivieri, Francesca Pizzolo, Patrizia Guarini, Laura Chiecchi, Annalisa Castagna, Ricciarda Raffaelli, Muthukumar Gunasekaran, Letizia Consoli, Gian Luca Salvagno, Kenichiro Kitamura
    Abstract:

    Prostasin, a glycosylphosphatidylinositol (GPI)-anchored serine protease, activates the epithelial sodium (Na) channel (ENaC), and prostasin is released in extracellular fluids, including urine. Previous data have suggested a direct association between urinary prostasin and the activation of an aldosterone-driven pathway, but a quantitative association has never been demonstrated in normotensive subjects. Similarly, physiological relationships with natriuresis or possible gender- or female hormone-related changes in urinary prostasin concentRations have never been investigated. We measured urinary prostasin by enzyme-linked immunosorbent assay in 43 healthy normotensive subjects of similar age presenting different urinary Na levels and in 15 women during the menstrual cycle and after oral estro-progestinic contraceptive (OC) therapy. Exosomal urinary prostasin was also estimated by western blotting of samples from six healthy subjects twice during the morning. Urinary prostasin presented a wide range of values (from 0.5 to 18.9 nM) without gender differences. It was positively correlated with the aldosterone to renin Ratio (ARR) but not with circulating aldosterone or renin individually. Urinary prostasin was directly correlated with U-Na levels (up to 200 nmol Na), whereas it decreased for higher Na concentRations. In women, no significant changes of prostasin concentRation were observed during menstrual phases. After OC therapy, prostasin increased (from 2.37±1.27 to 4.85±5.28 nM), although the increase was not statistically different (P=0.07). Prostasin was detectable in urinary exosomes and displayed a pattern similar to urinary prostasin in relation to urinary Na. In conclusion, urinary prostasin correlates with the ARR, and it is physiologically modulated by natriuresis in normotensive individuals.

  • Antihypertensive efficacy of spironolactone: what about sex?
    Journal of hypertension, 2011
    Co-Authors: Francesca Pizzolo, Oliviero Olivieri
    Abstract:

    We read with interest the paper of Parthasarathy et al. [1], investigating the blood pressure (BP) response to two different diuretics [a mineralocorticoid receptor antagonist (MRA) and a thiazide diuretic] in patients subdivided, according to Aldosterone-to-Renin Ratio (ARR) value, in high and low ARR group, respectively. Given the high incidence of primary aldosteronism and the widely recognized adverse effects of aldosterone on cardiovascular system, further research on MRA use in hypertensive patients is warranted.

  • Effects of female sex hormones and contraceptive pill on the diagnostic work-up for primary aldosteronism.
    Journal of hypertension, 2010
    Co-Authors: Francesca Pizzolo, Chiara Pavan, Patrizia Guarini, Roberto Corrocher, Laura Chiecchi, Ricciarda Raffaelli, Alessia Memmo, Gian Cesare Guidi, Massimo Franchi, Oliviero Olivieri
    Abstract:

    ObjectivesDue to the widespread use of the aldosterone to renin Ratio (ARR), primary aldosteronism is currently recognized as a frequent cause of secondary hypertension. After a positive screening, primary aldosteronism diagnosis needs confirmation by an inhibitory test such as intravenous saline lo

  • Aldosterone to Renin Ratio (ARR) in Clinical use, with Reference to the Primary Care Setting: ARR to Whom, When, How, What for?
    Current Hypertension Reviews, 2008
    Co-Authors: Oliviero Olivieri, Francesca Pizzolo, Roberto Corrocher
    Abstract:

    Compelling evidence indicates that primary aldosteronism (PA) is the most frequent cause of secondary hypertension, with an estimated prevalence ranging from 10 to 15% in the population referred to specialist hypertension units. In clinical practice, the aldosterone to renin Ratio (ARR) is the cornerstone of population screening, although difficulties in methodology and thus in defining precise cut-off values still represent an area of uncertainty. In hypertensive subjects, the elevated ARR is a marker of inappropriately high aldosterone secretion for the degree of renin-angiotensin system activation, and often is the only index capable of distinguish normokalemic PA from essential hypertension. On the basis of such a high prevalence, it is unclear whether ARR measurement should be reserved for selected subgroups of patients, or extended to all hypertensive subjects in the population as a whole. In unselected, normotensive populations elevated aldosterone levels and elevated ARR have recently been reported as predisposing factors to the subsequent development of hypertension, raising the question of the optimal timing for ARR measurement, especially in those with a family history of hypertension in primary care. In a large proportion of patients presenting elevated ARR the diagnosis of PA is formally ruled out by confirmatory/ exclusion testing, although the clinical relevance of “inappropriate aldosterone secretion” in these patients remains unclear. May it serve as a predictor of the usefulness of mineralocorticoid receptor antagonist treatment? These and related questions will be examined in this review, particularly given clearly unsatisfactory levels of BP control even in the populations of Western countries.

  • Menopause Not Aldosterone-to-Renin Ratio Predicts Blood Pressure Response to a Mineralocorticoid Receptor Antagonist in Primary Care Hypertensive Patients
    American journal of hypertension, 2008
    Co-Authors: Oliviero Olivieri, Francesca Pizzolo, Roberto Corrocher, Alberto Ciacciarelli, Denise Signorelli, Salvatore Falcone, Gian S. Blengio
    Abstract:

    BACKGROUND It has been suggested that hypertensive patients with raised Aldosterone-to-Renin Ratio (ARR) are specifically sensitive to mineralocorticoid receptor antagonists (MRAs). We have previously shown that patients with an elevated ARR are relatively frequent in the setting of primary care. We therefore designed an interventional study to ascertain whether primary care hypertensive patients with an elevated ARR presented a superior response to MRA treatment than subjects with normal Ratio. METHODS According to the previously observed distribution in general population, 1/3 and 2/3 of hypertensive patients with high or normal ARR, respectively, were treated with kanrenoate 50-100 mg/day for 2 months. To avoid uncontrolled blood pressure (BP), 49% of patients continued also "ARR-neutral" drugs such as verapamil and/or alpha-adrenergic blockers. Patients groups were matched for most features but an elevated ARR was more frequent in female than in male gender; moreover, 90% of women with raised ARR were in menopause. RESULTS A clear reduction of BP values was recorded after both the first and the second month of treatment with kanrenoate, with the maximal effect obtained when the dosage titRation at 100 mg/day was accomplished. However, patients previously identified by a raised ARR did not have a larger response to MRA treatment than patients with normal Ratio. In contrast, MRA was twofold more effective in reducing SBP in women than in men (after 2 months of treatment -16.4 mm Hg vs.-8.2 mm Hg). CONCLUSIONS These results suggest that postmenopausal hypertension is largely dependent on mineralocorticoid receptor activation and selectively sensitive to MRAs.

Martin Reincke - One of the best experts on this subject based on the ideXlab platform.

  • Update endokrine Hypertonie
    Der Internist, 2018
    Co-Authors: Benjamin Lechner, Felix Beuschlein, Daniel A. Heinrich, Svenja Nölting, A. Osswald-kopp, German Rubinstein, J. Sauerbeck, Martin Reincke
    Abstract:

    Endocrine disorders are the most common causes of secondary hypertension. Early diagnosis and specific treatment are crucial for improvement of the prognosis. This article provides an overview on which clinical constellations point to an increased risk of secondary causes of hypertension. These include spontaneous hypokalemia, young age at onset of hypertension, adrenal incidentaloma and therapy refractive arterial hypertension. The basic diagnostics include determination of the aldosterone to renin Ratio, measurement of free plasma metanephrines and a 1 mg dexamethasone suppression test. Borderline results require repeated control testing and/or confirmatory testing under standardized test conditions. In cases of repeatedly conspicuous results referral to a specialized clinic should be considered for further clarification and confirmation of the diagnosis. Imaging diagnostics may constitute an adjunct to laboratory testing after the diagnosis has been confirmed. Therapeutic algorithms vary depending on the underlying endocrine disease.

  • Dataset of the associations of aldosterone to renin Ratio with MR-proANP and MR-proADM.
    Data in brief, 2016
    Co-Authors: Cornelia Then, Martin Bidlingmaier, Marietta Rottenkolber, Andreas Lechner, Christa Meisinger, Margit Heier, Wolfgang Koenig, Annette Peters, Wolfgang Rathmann, Martin Reincke
    Abstract:

    This article contains data related to the research article entitled “Altered relation of the renin-aldosterone system and vasoactive peptides in type 2 diabetes: the KORA F4 study” (Then et al., 2016) [1] and describes the association of the aldosterone to renin Ratio with midregional-pro atrial natriuretic peptide (MR-proANP) and midregional-pro adrenomedullin (MR-proADM) in 1261 participants from the KORA F4 cohort.

  • Clinical validation for the Aldosterone-to-Renin Ratio and aldosterone suppression testing using simultaneous fully automated chemiluminescence immunoassays.
    Journal of hypertension, 2015
    Co-Authors: J. Manolopoulou, Evelyn Fischer, Anna Dietz, Sven Diederich, Daniel T. Holmes, Riia K. Junnila, Philipp Grimminger, Martin Reincke, Alberto Morganti, Martin Bidlingmaier
    Abstract:

    Background:As larger numbers of hypertensive patients are screened for primary aldosteronism with the Aldosterone-to-Renin Ratio (ARR), automated analyzers present a practical solution for many laboratories. We report the method-specific ARR cutoff determined with direct, automated chemiluminescence

  • Assay characteristics influence the aldosterone to renin Ratio as a screening tool for primary aldosteronism: results of the German Conn's registry.
    Hormone and Metabolic Research, 2013
    Co-Authors: Evelyn Fischer, Martin Bidlingmaier, S. Reuschl, Marcus Quinkler, Lars Christian Rump, Stephanie Hahner, Martin Reincke
    Abstract:

    Primary aldosteronism (PA) is the most frequent cause of secondary arterial hypertension. The aldosterone to renin Ratio (ARR) is the gold standard for screening, but variability between biochemical methods used remains of concern. The aim of the study was to analyze center-specific features of biochemical diagnostic strategies prior to the 2008 consensus within the German Conn’s Registry. The study was designed as a retrospective study in 5 tertiary care hospitals. Patients analyzed for PA between 1990 and 2006 were studied. Characteristics of the assays used to determine ARR during establishing the diagnosis of PA were analyzed in the retrospective part of the German Conn’s Registry. Eighty-six out of 484 documented ARR values had to be excluded from further evaluations because the laboratory or the assays were unknown. In the remaining 398 patients ARR was determined using 10 different assay combinations in the centers (aldosterone plus plasma renin activity or concentRation). Considerable differences were seen between the mean concentRations for aldosterone (p

  • A high aldosterone to renin Ratio is associated with high serum parathyroid hormone concentRations in the general population.
    The Journal of clinical endocrinology and metabolism, 2013
    Co-Authors: Evelyn Fischer, Anke Hannemann, Rainer Rettig, Wolfgang Lieb, Matthias Nauck, Anna Pallauf, Martin Bildingmaier, Felix Beuschlein, Henri Wallaschofski, Martin Reincke
    Abstract:

    Context: Activation of the renin-angiotensin-aldosterone system (RAAS) is associated with high serum PTH concentRations and vice versa. Objective: The aim of this study was to analyze the associations of the plasma aldosterone concentRation (PAC), the plasma renin concentRation (PRC), or the aldosterone to renin Ratio (ARR) with serum PTH concentRations in a sample from the general population of northeast Germany. Design: We selected 3105 subjects (25–88 y) from the first 5-year follow-up examination of the Study of Health in Pomerania. The associations of PAC, PRC, or ARR with serum PTH concentRations were examined with multivariable linear regression analyses. We further calculated adjusted mean serum PTH concentRations according to PAC, PRC, and ARR categories (≥90th and < 90th sex specific percentiles and sex specific quartiles). The models were adjusted for age, sex, estimated glomerular filtRation rate, serum 25-hydroxy vitamin D concentRation, waist circumference, body mass index, hypertension, dia...

Michihiro Satoh - One of the best experts on this subject based on the ideXlab platform.

  • Association of Aldosterone-to-Renin Ratio With Hypertension Differs by Sodium Intake: The Ohasama Study
    American journal of hypertension, 2014
    Co-Authors: Michihiro Satoh, Masahiro Kikuya, Azusa Hara, Takuo Hirose, Hirohito Metoki, Ryusuke Inoue, Miki Hosaka, Kei Asayama, Megumi Tsubota-utsugi, Taku Obara
    Abstract:

    background In cross-sectional studies, the Aldosterone-to-Renin Ratio (ARR) has been reported to be associated with hypertension under conditions of higher sodium intake. The objective of this prospective study was to investigate the association between ARR and the development of hypertension in community residents stratified by dietary sodium intake. methods From the general population of Ohasama, we obtained plasma renin activity (PRA) and plasma aldosterone concentRations (PACs) for 608 participants (mean age = 57.6 years; 71.4% women) without hypertension at baseline. Using the Cox model, we computed the adjusted hazard Ratio (HR) of natural log-transformed ARR (lnARR) for the development of hypertension, defined as blood pressure ≥140/90 mm Hg or start of treatment with antihypertensive drugs during follow-up. results During a mean follow-up of 6.8 years, 298 participants developed hypertension. The median PRA, PAC, and ARR were 1.2 ng/ml/hour, 6.6 ng/dl, and 5.5 ng/dl per ng/ml/hour, respectively. Each 1 SD increase in lnARR was associated with an increased risk for the development of hypertension in participants overall (HR = 1.18; P = 0.007). In participants with higher sodium intake (median ≥4,102 mg/day), a significant association of lnARR with hypertension remained (HR = 1.25; P = 0.009), whereas no significant association was observed in participants with lower sodium intake (P = 0.18). Participants who developed hypertension had significantly lower PRA than those who did not ( P = 0.003), despite no differences in PAC ( P = 0.91).

  • Aldosterone-to-Renin Ratio and nocturnal blood pressure decline assessed by self-measurement of blood pressure at home: the Ohasama Study.
    Clinical and experimental hypertension (New York N.Y. : 1993), 2014
    Co-Authors: Michihiro Satoh, Masahiro Kikuya, Azusa Hara, Takuo Hirose, Hirohito Metoki, Ryusuke Inoue, Miki Hosaka, Kei Asayama, Megumi Utsugi, Taku Obara
    Abstract:

    AbstractBased on ambulatory blood pressure (BP) monitoring, the Aldosterone-to-Renin Ratio (ARR) has been reported to be associated with a diminished nocturnal decline in BP, generally referred to as a “non-dipping” pattern. The objective of this cross-sectional study was to investigate the association between ARR and the non-dipping pattern based on home BP measurements. This study included 177 participants ≥55 years from the general population of Ohasama (mean age: 67.2 years; 74.6% women); no patient was receiving antihypertensive treatment. The median plasma renin activity (PRA), plasma aldosterone concentRation (PAC) and ARR were 0.8 ng/mL/h, 8.1 ng/dL and 9.7 ng/dL per ng/mL/h, respectively. Each 1 SD increase in log-transformed (ln) ARR was significantly associated with the prevalence of the non-dipping pattern after adjustments for possible confounding factors including home morning systolic BP (odds Ratio, 1.45; p = 0.049). However, no significant associations of PRA or PAC with the non-dipping p...

  • Aldosterone-to-Renin Ratio as a Predictor of Stroke Under Conditions of High Sodium Intake: The Ohasama Study
    American journal of hypertension, 2012
    Co-Authors: Michihiro Satoh, Masahiro Kikuya, Takayoshi Ohkubo, Takanao Hashimoto, Azusa Hara, Takuo Hirose, Hirohito Metoki, Megumi Utsugi, Takefumi Mori, Taku Obara
    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. METHODS We 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 ± 11.3 years; 65.6% women). RESULTS Over 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. CONCLUSION These results suggest that high ARR, that is, relative aldosterone excess, is a predictor for stroke under conditions of high sodium intake.

  • Plasma renin activity and the Aldosterone-to-Renin Ratio are associated with the development of chronic kidney disease: the Ohasama Study.
    Journal of hypertension, 2012
    Co-Authors: Shiho Terata, Masahiro Kikuya, Michihiro Satoh, Takayoshi Ohkubo, Takanao Hashimoto, Azusa Hara, Takuo Hirose, Taku Obara, Hirohito Metoki, Ryusuke Inoue
    Abstract:

    Background:The Aldosterone-to-Renin Ratio (ARR) is used to screen for primary aldosteronism and could be an index for salt sensitivity. The association between ARR and the development of chronic kidney disease (CKD) is completely unknown.Method:A longitudinal observational study involving 689 partic

  • Aldosterone-to-Renin Ratio and nocturnal blood pressure decline in a general population: the Ohasama study.
    Journal of hypertension, 2011
    Co-Authors: Michihiro Satoh, Masahiro Kikuya, Takayoshi Ohkubo, Takanao Hashimoto, Azusa Hara, Takuo Hirose, Hirohito Metoki, Megumi Utsugi, Takefumi Mori, Taku Obara
    Abstract:

    BackgroundAldosterone-to-Renin Ratio (ARR) is an index for inappropriate aldosterone activity and salt sensitivity. We previously reported that elevated ARR might be associated with salt-sensitive hypertension. Because salt-sensitive hypertensive patients are reported to show a diminished nocturnal