Abstract
Plasma aldosterone and renin levels have been associated with blood pressure increase and 3–4 year incidence of hypertension in a middle-aged North American community in Framingham. To confirm these findings in a different population, a nested case–control study was performed in a national sample of 1984 French non-hypertensive volunteers aged 45–64 year and followed for 5 years. Cases and controls (individuals becoming hypertensive or remaining non-hypertensive on follow-up) were individually matched on sex, diastolic and systolic pressures at baseline. Multivariable regression models show that plasma aldosterone and renin are respectively positively and negatively associated with the increase in systolic pressure (P=0.01 and 0.001) and the risk of hypertension (22% increase and 16% decrease per s.d. increment in the log, P=0.04 and 0.07). These associations are mostly observed in the lowest tertiles of dietary sodium and potassium intakes where plasma aldosterone is positively associated with the increase in systolic pressure (P=0.01 and 0.08) and the risk of hypertension (59 and 69% increase per s.d. increment in the log, P=0.02 and 0.01), whereas plasma renin is negatively associated with the increase in systolic pressure (P=0.0004 and 0.004) and the risk of hypertension (31 and 28% decrease per s.d. increment in the log, P=0.03 and 0.05). These results reinforce the hypothesis that high plasma aldosterone and low plasma renin levels precede blood pressure increase and the occurrence of hypertension in middle-aged Caucasian populations.
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References
Laragh JH . Vasoconstriction-volume analysis for understanding and treating hypertension: the use of renin and aldosterone profiles. Am J Med 1973; 55 (3): 261–274.
Laragh JH . Renin profiling for diagnosis, risk assessment, and treatment of hypertension. Kidney Int 1993; 44 (5): 1163–1175.
Blaufox MD, Lee HB, Davis B, Oberman A, Wassertheil-Smoller S, Langford H . Renin predicts diastolic blood pressure response to nonpharmacologic and pharmacologic therapy. JAMA 1992; 267 (9): 1221–1225.
Preston RA, Materson BJ, Reda DJ, Williams DW, Hamburger RJ, Cushman WC et al. Age-race subgroup compared with renin profile as predictors of blood pressure response to antihypertensive therapy. JAMA 1998; 280 (13): 1168–1172.
Meade TW, Imeson JD, Gordon D, Peart WS . The epidemiology of plasma renin. Clin Sci (London) 1983; 64 (3): 273–280.
Meade TW, Cooper JA, Peart WS . Plasma renin activity and ischemic heart disease. N Engl J Med 1993; 329 (9): 616–619.
Alderman MH, Madhavan S, Ooi WL, Cohen H, Sealey JE, Laragh JH . Association of the renin-sodium profile with the risk of myocardial infarction in patients with hypertension. N Engl J Med 1991; 324 (16): 1098–1104.
Vasan RS, Evans JC, Larson MG, Wilson PW, Meigs JB, Rifai N et al. Serum aldosterone and the incidence of hypertension in nonhypertensive persons. N Engl J Med 2004; 351 (1): 33–41.
Wang TJ, Gona P, Larson MG, Levy D, Benjamin EJ, Tofler GH et al. Multiple biomarkers and the risk of incident hypertension. Hypertension 2007; 49 (3): 432–438.
Newton-Cheh C, Guo CY, Gona P, Larson MG, Benjamin EJ, Wang TJ et al. Clinical and genetic correlates of aldosterone-to-renin ratio and relations to blood pressure in a community sample. Hypertension 2007; 49 (4): 846–856.
Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D et al. The SU.VI. MAX study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med 2004; 164 (21): 2335–2342.
de Wardener HE, MacGregor GA . Harmful effects of dietary salt in addition to hypertension. J Hum Hypertens 2002; 16 (4): 213–223.
Meneton P, Jeunemaitre X, de Wardener HE, MacGregor GA . Links between dietary salt intake, renal salt handling, blood pressure, and cardiovascular diseases. Physiol Rev 2005; 85 (2): 679–715.
Sealey JE, Laragh JH . The renin—angiotensin–aldosterone system for normal regulation of blood pressure and sodium and potassium homeostasis.In: Laragh JH, Brenner BM (eds). Hypertension: Pathophysiology, Diagnosis and Management. Raven Press: New York, 1995,pp 1763–1796.
Czernichow S, Bertrais S, Blacher J, Galan P, Briancon S, Favier A et al. Effect of supplementation with antioxidants upon long-term risk of hypertension in the SU.VI. MAX study: association with plasma antioxidant levels. J Hypertens 2005; 23 (11): 2013–2018.
Menard J, Guyenne TT, Corvol P, Pau B, Simon D, Roncucci R . Direct immunometric assay of active renin in human plasma. J Hypertens Suppl 1985; 3 (Suppl 3): S275–S278.
Sealey JE . Plasma renin activity and plasma prorenin assays. Clin Chem 1991; 37 (10 Part 2): 1811–1819.
Mennen LI, Bertrais S, Galan P, Arnault N, Potier de Couray G, Hercberg S . The use of computerised 24 h dietary recalls in the French SU.VI. MAX study: number of recalls required. Eur J Clin Nutr 2002; 56 (7): 659–665.
Feinberg M, Favier CJ, Ireland-Ripert J . Répertoire général des aliments. Technique & Documentation-Lavoisier: Paris, 1991, 282pp.
Dluhy RG, Williams GH . Aldosterone—villain or bystander? N Engl J Med 2004; 351 (1): 8–10.
Tuck ML, Dluhy RG, Williams GH . Sequential responses of the renin–angiotensin–aldosterone axis to acute postural change: effect of dietary sodium. J Lab Clin Med 1975; 86 (5): 754–763.
Brunner HR, Laragh JH, Baer L, Newton MA, Goodwin FT, Krakoff LR et al. Essential hypertension: renin and aldosterone, heart attack and stroke. N Engl J Med 1972; 286 (9): 441–449.
Rosei EA, Brown JJ, Cumming AM, Fraser R, Semple PF, Lever AF et al. Is the ‘sodium index’ a useful way of expressing clinical plasma renin, angiotensin and aldosterone values? Clin Endocrinol (Oxf) 1978; 8 (2): 141–147.
Birkenhager WH, Schalekamp MA, Krauss XH, Kolsters G, Schalekamp-Kuyken MP, Kroon BJ et al. Systemic and renal haemodynamics, body fluids and renin in benign essential hypertension with special reference to natural history. Eur J Clin Invest 1972; 2 (2): 115–122.
Grim CE, Weinberger MH, Henry DP, Luft FC, Fineberg NS . Biochemical correlates of the increase in blood pressure with age. Clin Sci Mol Med Suppl 1978; 4: 377s–379s.
Thomas GW, Ledingham JG, Beilin LJ, Stott AN, Yeates KM . Reduced renin activity in essential hypertension: a reappraisal. Kidney Int 1978; 13 (6): 513–517.
Thurston H, Bing RF, Pohl JE, Swales JD . Renin subgroups in essential hypertension: an analysis and critique. Q J Med 1978; 47 (187): 325–337.
Vetter H, Glanzer K, Vetter W . Essential hypertension: relationship between renin and blood pressure. Clin Exp Hypertens 1980; 2 (3–4): 553–561.
Alderman MH, Cohen HW, Sealey JE, Laragh JH . Plasma renin activity levels in hypertensive persons: their wide range and lack of suppression in diabetic and in most elderly patients. Am J Hypertens 2004; 17 (1): 1–7.
Williams GH, Hollenberg NK, Moore TJ, Dluhy RG, Bavli SZ, Solomon HS et al. Failure of renin suppression by angiotensin II in hypertension. Circ Res 1978; 42 (1): 46–52.
Swales JD . On the inappropriate in hypertension research. Lancet 1977; 2 (8040): 702–704.
Wald NJ, Hackshaw AK, Frost CD . When can a risk factor be used as a worthwhile screening test? BMJ 1999; 319 (7224): 1562–1565.
Pepe MS, Janes H, Longton G, Leisenring W, Newcomb P . Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker. Am J Epidemiol 2004; 159 (9): 882–890.
D’Agostino RB . Risk prediction and finding new independent prognostic factors. J Hypertens 2006; 24 (4): 643–645.
Azizi M, Bissery A, Bura-Riviere A, Menard J . Dual renin–angiotensin system blockade restores blood pressure-renin dependency in individuals with low renin concentrations. J Hypertens 2003; 21 (10): 1887–1895.
Bautista LE . Inflammation, endothelial dysfunction, and the risk of high blood pressure: epidemiologic and biological evidence. J Hum Hypertens 2003; 17 (4): 223–230.
Kurtz A, Wagner C . Role of nitric oxide in the control of renin secretion. Am J Physiol 1998; 275 (6 Part 2): F849–F862.
Muldowney III JA, Davis SN, Vaughan DE, Brown NJ . NO synthase inhibition increases aldosterone in humans. Hypertension 2004; 44 (5): 739–745.
Freel EM, Connell JM . Mechanisms of hypertension: the expanding role of aldosterone. J Am Soc Nephrol 2004; 15 (8): 1993–2000.
Julius S, Nesbitt SD, Egan BM, Weber MA, Michelson EL, Kaciroti N et al. Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med 2006; 354 (16): 1685–1697.
Acknowledgements
We are grateful to Dr Tanh Tam Guyenne (INSERM U872) for performing aldosterone assays and to Mrs Marie-Françoise Gonzalez (INSERM U872) for performing plasma renin activity assays. We thank the Fondation Robert Debré and the Institut National pour la Santé et la Recherche Médicale for their funding.
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Meneton, P., Galan, P., Bertrais, S. et al. High plasma aldosterone and low renin predict blood pressure increase and hypertension in middle-aged Caucasian populations. J Hum Hypertens 22, 550–558 (2008). https://doi.org/10.1038/jhh.2008.27
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DOI: https://doi.org/10.1038/jhh.2008.27
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