Prevalence of essential hypertension associated with elevated aldosterone to renin ratio in kashmir valley. a case control study

Background: Despite growing burden of hypertension, its pathophysiology is still incompletely understood. Although implicated in pathogenesis of hypertension, the role of aldosterone and renin is not completely elucidated.
Aim: This study was aimed to acquire baseline data about the prevalence of essential hypertension associated with an elevated aldosterone to renin ratioby studying plasma aldosteroneconcentration and plasma renin activity.
Methods: One hundred hypertensive patients and fifty normal individuals were enrolled. All antihypertensive medications were stopped for four weeks before measuringaldosterone concentration and plasma renin activity. An aldosterone-renin ratio of ≥25 was taken as elevated.
Results: The prevalence of essential hypertension with elevatedaldosterone-renin ratiowas 19% in our population. Mean aldosterone concentration, mean plasma renin activityand aldosterone-renin ratio was 5.8ng/dl (range 1.1-15.9), 1.0 ng/ml/hr and 14.6 (range 0.5-69.6) respectively. Inaldosterone associated hypertension group, 68.4% (n=13) had systolic blood pressure of ≥160 mmHg while 52.6% (n=10) had diastolic blood pressure of ≥100 mmHg. The mean systolic blood pressure of patients with high aldosterone-renin ratio was 160.1mmHg (± 8.1) while mean systolic blood pressure of patients with normal aldosterone-renin ratio was 157.0mmHg (±10.6) which was statistically significant (p=0.04). In addition, relatively higher aldosterone-renin ratiowas observed in patients with stage II hypertension as compared to stage I hypertension.
Conclusion: One-fifth of essential hypertensive patients had elevated ARR (Aldosterone associated hypertension) in this study. Thus Aldosterone antagonists may be a more appropriate and cost effective antihypertensive drug for these patients. Further controlled trials capable of demonstrating the hypothesis are mandatory.