Abstract：
To investigate the predictive ability of direct plasma renin and aldosterone concentrations as well as their ratio [aldosterone-to-renin (ARR)] for incident hypertension in the general population.
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.
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.
摘要：
目的：探讨直接血浆肾素和醛固酮浓度及其比值（醛固酮与肾素（ARR））对普通人群高血压的预测能力。
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。
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。
