Background: The renin-angiotensin-aldosterone-system (RAAS) is a major regulator of blood pressure, however, there are no studies available addressing its characterization in a large clinical setting. Therefore, the aim of the present study was to describe the relationship between parameters of the RAAS and actual blood pressure results in a large cohort of patients with and without essential hypertension.
Methods: We investigated 3253 patients (ages 63.2±10 years) who were scheduled for coronary angiography in a single tertiary centre. We formed quartiles (QU) according to aldosterone/renin ratio (ARR; pg/ml).
Results: Sixty-nine percentage of the patients were hypertensive (s/dBP ≥140/90 mmHg) and mean systolic (sBP) and diastolic (dBP) blood pressure was 141±23 and 80±11 mmHg in the entire cohort. ARR in men was 10.1±15.6 and in women 14.1±19.7 (P<0.005). In a multivariate model, adjusting for age, sex, BMI, diabetes mellitus, NT-pro-BNP, daily activity, cystatin C, CRP, specific antihypertensive therapy mean sBP of ARR QU1 was 130.9 and increased to 147.2 mmHg in QU4. Diastolic BP increased significantly from 75.7 (QU1) to 85.1 mmHg (QU4), all P values <0.001. The overall influence of antihypertensive medication on ARR was rather small: ACE inhibitors decreased ARR to 9.8 (without ACE: 13.3), as well as diuretics (ARR 9.5 vs 12.2), whereas beta blockers increased ARR to 12.7 (vs 9.3) as did calcium channel blockers (13.9 vs 11.0). In a multivariate stepwise regression model overall predictable variance of sysBP was 28% (R2) and of dBP 22.6%. Here, the ARR was the single and second most important predictor of systolic and diastolic BP values.
Conclusions: ARR accounts for a large part of the variation in BP values and is also an important modulator of BP values in normotensive subjects.
03 - 07 May 2008
European Society of Endocrinology