Aldosterone to renin ratio as a determinant of exercise blood pressure response in hypertensive patients

Aldosterone to renin ratio (ARR) is a marker of inappropriate aldosterone a ctivity in hypertension. Since aldosterone may adversely affect vascular co mpliance, we hypothesised that the ARR would relate to exercise blood press ure (BP) responses in hypertension. Blood sampling was done in untreated hy pertensives for plasma renin activity (PRA, ng/mL/hr) and plasma aldosteron e (PA, pmol/L). ARR was derived by dividing the PA value by the PRA value, and this index was normalised by natural logarithm (InARR) for further anal yses. Each patient underwent 24-h ambulatory BP (ABP), and a 3-min submaxim al exercise test using the Dundee Step Test. The Spearman rank correlation coefficients between InARR and office BP (OBP), ABP and exercise BPs and BP changes estimated during exercise were assessed. A total of 119 (66 males) hypertensive subjects aged 48 (s.d. 12) years were studied. The respective OBP, ABP, exercise BP and the change in exercise BP were 167(23)/105(11), 140(15)187(10), 189(26)/107(12) and 25(15)/2(9)mmHg. InARR was significantl y correlated with exercise systolic BP (r = 0.24, P < 0.001), exercise dias tolic BP (r = 0.23, P < 0.05), systolic ABP (r = 0.22, P < 0.05) and systol ic OBP (r = 0.19, P < 0.05). In a multiple regressional analysis controllin g for age and sex and all other BP measurements to assess the relative stre ngths of correlation between all the BP indices with InARR, only exercise s ystolic BP (P = 0.012) and the change in systolic BP during exercise (negat ively, P = 0.013) emerged as significant independent predictors of InARR. I n conclusion, there was an independent and significant correlation between ARR and exercise systolic BP.