Relationship Between the Aldosterone-to-Renin Ratio and Blood Pressure in Young Adults: A Longitudinal Study

Abstract

Hypertension tracks throughout childhood into adulthood. Elevated aldosterone in the setting of low renin predicts incident hypertension in normotensive adults, but the relationship is unclear in adolescents and young adults. To explore this relationship, we analyzed data from the offsprings (Gen2) of women enrolled during pregnancy into the Raine Study (population-based birth cohort), who had blood pressure (BP) measurements and blood samples at age 17 years (N=871) and age 27 years (N=758). At 17 years, females had similar median aldosterone levels (349 versus 346 pmol/L) but significantly lower direct renin concentration (20.6 versus 25.7 mU/L) and thus a higher aldosterone-to-renin ratio (ARR; 18.3 versus 13.5) compared with males. However, females had lower systolic BP (109 versus 118 mm Hg) versus males. A significant association between ARR and systolic BP was detected in 17 years males when adjusted for alcohol consumption, physical activity, and body mass index. This was true whether the ARR was expressed as a continuous variable (β-coefficient 0.1, P =0.009) or categorical variable (highest versus lowest quartile, β-coefficient 3.15, P =0.003). No such correlation was observed in females at 17 years. However, the ARR at 17 years was significantly associated with both systolic (β-coefficient 0.15, P =0.009) and diastolic BP (β-coefficient 0.14, P =0.003) at 27 years among females, but not males. The sexually dimorphic relationship between the ARR and BP in 17 and 27 years participants suggests that the ARR, calculated from the plasma aldosterone concentration and direct renin concentration, could be a useful tool for BP prediction and assessment in young people, but require sex-specific interpretation.

Aldosterone and renin concentrations and blood pressure in young Indigenous and non‐Indigenous adults in the Northern Territory: a cross‐sectional study

“…The proportions were similar to that reported in a recent Australian prevalence study, which found that ARR values exceeded 70 pmol/mU in 25% of people newly diagnosed with hypertension (mean age, 55 years) 19 . On the other hand, only two of 758 participants in the Western Australia Raine Study (age, 27 years) had elevated ARR values using the same threshold 20 . It is unclear why the prevalence of elevated ARRs was higher among our urban ABC and TEC participants.…”

Does the Aldosterone: Renin Ratio Predict Future Blood Pressure in Young Adults?

“…Beyond the provision of normal range ARR values, the Yang et al 5 study does demonstrate the association of ARR with BP over time, under limited circumstances and with some interesting caveats. A significant association between ARR and systolic BP only was observed at 17 years of age in males but not in females.…”

“…To that end, Yang et al 5 in this issue make a substantial contribution to the provision of normative, sex-appropriate renin, aldosterone, and ARR values for healthy young adults, filling a knowledge gap that has heretofore limited ARR as a reliable screening test for the detection of primary aldosteronism in this age group. This relatively large cohort study examined the relationship of renin, aldosterone, and ARR to BP in a primarily normotensive population of young adults from birth to 17 (871 participants) and 27 (758 participants) years of age.…”

“…In other words, the current threshold for identification of autonomous aldosterone production may be set too high and if so, primary aldosteronism may underlie a significant proportion of primary hypertension. While the Yang et al 5 report provides a normal range for ARR values in young adults, ARR may not be sensitive enough to reliably detect autonomous aldosterone production, which may require the more integrated measure of 24-hour urinary aldosterone excretion during high dietary sodium intake in adults with hypertension and suppressed circulating renin. 8…”

“…9 This and other studies highlighted in the recent American Heart Association Scientific Statement 10 on the management of stage 1 hypertension in adults with a low 10-year risk for cardiovascular disease underscore the importance of understanding the pathophysiology of hypertension, including the role of unrecognized renin-independent aldosterone production, in this age group. The Yang et al 5 study starts us in this direction, but the assessment of autonomous aldosterone production and its relationship to BP will require more careful phenotyping of hypertensive young adults with and without suppressed renin using dietary sodium loading and urinary aldosterone measurement in the future.…”