Concentration of renin and aldosterone were measured by a chemiluminescence immunoassay using the fully automated LIAISON® platform (DiaSorin) among 5362 participants of the population-based Gutenberg Health Study, who were normotensive and had no clinically overt cardiovascular disease at baseline. During a follow-up period of 5 years, 18.6% (n = 996) developed a new-onset hypertension. Comparing extreme quartiles of biomarker distribution, the relative risk (RR) for incident arterial hypertension was found to be 1.58 [95% confidence interval (CI) 1.25-2.00; P = 0.00015; Q1 vs. Q4ref] for renin; 1.29 (95% CI 1.05-1.59, P = 0.018; Q4 vs. Q1ref) for aldosterone and 1.70 (95% CI 1.33-2.12; P < 0.0001; Q4 vs. Q1ref) for ARR after multivariable adjustment in men. In females, only high ARR was independently predictive for incident hypertension over 5 years [RR 1.29 (95% CI 1.04-1.62); P = 0.024]. Even in the subgroup of individuals having biomarker concentrations within the reference range, high ARR was predictive for new-onset hypertension in men [RR 1.44 (95% CI 1.13-1.83); P = 0.003]. Finally, synergistic effects of co-prevalent obesity and ARR on incident hypertension were also demonstrated, resulting in markedly higher risk estimates as seen for biomarker alone [RR of 2.70 (95% CI 2.05-3.6) for Q4 of ARR and having body mass index ≥ 30 kg/m2 vs. low ARR (Q1ref) and normal weight; P < 0.0001].
Among normotensives from the general population ARR possesses a stronger predictive value for incident hypertension than renin or aldosterone alone. The prediction of arterial hypertension by ARR was even stronger in obese subjects.
结果:使用全自动LIAISON®平台(DiaSorin),通过化学发光免疫分析法(CLIA)对基于人群的Gutenberg健康研究的5,362名参与者进行了肾素和醛固酮的浓度。他们血压正常,基线时没有临床上明显的CVD。在五年的随访期间,18.6%(n=996)发展为新发高血压。比较生物标志物分布的极端四分位数,肾素的相对风险(RR)为1.58(95%置信区间(CI)1.25-2.00;p=0.00015;Q1vsQ4ref);醛固酮为1.29(95%CI1.05-1.59,p=0.018;Q4vsQ1ref);ARR调整后男性为1.70(95CI1.33-2.12;p变量<0.0001;Q4vsQ1ref).在女性中,仅高ARR可独立预测5年以上的高血压(RR1.29(95%CI1.04-1.62);p=0.024).即使在生物标志物浓度在参考范围内的个体亚组中,高ARR可预测男性新发高血压(RR1.44(95CI1.13-1.83);p=0.003).最后,同时也证明了肥胖和ARR对高血压的协同作用。导致单独的生物标志物的风险估计值明显较高(ARR的第4季度的RR为2.70(95%2.05-3.6),BMI≥30kg/m2与低ARR(Q1ref)和正常体重;p<0.0001).
结论:在普通人群中,ARR对高血压事件的预测价值比单独的肾素或醛固酮更强。在肥胖受试者中,ARR对动脉高血压的预测甚至更强。
UNASSIGNED:这些发现可能有助于更好地理解醛固酮-肾素失衡对血压正常受试者新发高血压的重要性,并确定风险最大的个体。他们可能需要更密集的预防措施。