Relationship Between ARR And Target Organ Damage In Essential Hypertension

Objective:Hypertension is a well known risk factor for cardiovascular and cerebrovascular events.In addition,it is associated with earlier changes in organ systems in the body,such as left ventricular hypertrophy(LVH),proteinuria and renal failure,retinopathy and vascular dementia which are grouped under the term “target organ damage”(TOD).There are many factors involved in the pathogenesis of TOD and these include endothelial activation,platelet activation,increased thrombogenesis,Renin-angiotensin-aldosterone system molecules in local tissue and systemic effects,and collagen turnover.Allthese factors work and lead to the hypertensive TOD.The mechanism of RAAS system in the process of target organ injury of hypertension is not yet clear.Patients with primary aldosteronism have earlier and more severe target organ damage compared with patients with primary hypertension at the same level of blood pressure.ARR as a primary aldosteronism screening test showed better diagnostic accuracy.However,in patients with essential hypertension also have low renin,aldosterone relatively increased,the ARR ratio is increased.there is evidence that increased levels of aldosterone increased the risk of severe cardiovascular events.There are many reports about the relationship between ARR and TOD in foreign countries,but there are few reports in China.The aim of this study was to determine the relationship between ARR and TOD in essential hypertension.Methods:In this study,we involved 370 patients with primary hypertension form the Hypertension and Heart Failure department of first hospital affiliated to dalian medical university,from December 2015 to October 2016.All patients were followed up toexamine for target organ involvement,including left ventricularhypertrophy(LVH),carotid plaque or intima-media thickening(IMT),microalbuminuria,and estimated glomerular filtration rate(eGFR),24-hour ambulatory blood pressure monitoring,pulse wave velocity(PWV),flow mediated dilation(FMD).Measured ARR to calculate mean values(55.56(pg/ml)/(ng/ml/h))divided the patients into two groups namely high ARR group(> 55.56(pg/ml)/(ng/ml/h))and low ARR group(< 55.56(pg/ml)/(ng/ml/h)),and on behalf of heart damage parameters such as left ventricular mass index(LVMI),BNP;on behalf of kidney damage parameters such as eGFR,urine trace albuminuria/creatinine;on behalf of the arteriosclerosis parameters such as carotid intima-media thickness,PWV and FMD,and blood pressure values;Applying the correlation analysis between ARR and the parameters;Stepwisemultiple regression analysis was used to analyze the relationgship between ARR and carotid intima-media thickness,eGFR,PWV.Measurement data,which is consistent with the normol distribution,is expressed by mean±standard deviation(?±s).The comparison between groups is made by t test.The enumeration data is expressed by 100 percent,and the comparison between groups is made by chi-square test,and P<0.05 was defined as statistically different borderline.Results:370 patients with essential hypertension(EH)were included in this study,with 182 malesand188 females.Two groups in age,sex,body mass index,smoking,fasting plasma glucose,blood lipid,homocysteine,urinary MA/CRE,serum potassium concentration,blood serum sodium concentration,uric acid,serum creatinine,blood urea nitrogen,urine potassium,urinesodium,24 hSBP,24hDBP,24 hHR,LVMI,medication are had no statistical difference(P>0.05);In AI,ALD,ARR,BNP has statistical difference(P<0.05).In terms of heart,there was a correlation between ARR and BNP(r=0.206P=0.000),there was no relationship between ARR and SV1+ RV5(r=-0.026 P=0.623),and LVMI(r=0.045 P=0.383).In terms of the kidney,there was negative correlation between ARR and eGFR(r=-0.487 P=0.000),there was no relationship between ARR and urinary MA/CRE(r=-0.016P=0.753),and urea nitrogen(r=-0.067P=0.199),and serum creatinine(r=-0.066P=0.204).In terms of arteriosclerosis,there was a correlation between ARR and carotid intima-media thickness(r=0.585P=0.000),PWV(r=0.455 P=0.000),there was no relationship between ARR and FMD(r=-0.055P=0.287).In terms of Blood-pressure,there was a correlation between ARR and 24hSBP(r=0.226 P=0.000),24hDBP(r=0.149P=0.004),the average systolic blood pressure at day time(r=0.181 P=0.000),the daytime average diastolic blood pressure(r=0.121 P=0.020),the average night systolic blood pressure(r=0.191 P=0.000),the average diastolic blood pressure at night(r=0.120 P=0.021).there was no relationship between ARR and 24hHR(r=-0.084 P=0.109).Applying multiple stepwise regression analysis of the correlation of ARR and eGFR,averagePWV,carotid intima-media thickness.Take eGFR,averagePWV,carotid intima-media thickness as the dependent variable,take ARR,age,gender,smoking status,blood glucose,serum total cholesterol,triglycerides,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,blood uric acid,homocysteine,24 hSBP,24hDBP,24 hHR,concentration of serum sodium,serum potassium concentration,24 h urine sodium,24 h urinary potassium,drug as independent variables.There was a negative correlation between ARR and homocysteine,age,average systolic blood pressure and blood uric acid,eGFR.There was a positively correlation between ARR,and age,24 h SBP,24 h DBP,PWV.There was a correlation between age,ARR,gender,BMI,and the mean of the carotid intima-media thickness.Comparing target organ damage of high-ARR group with the low-ARR group: high average ARR BNP,carotid IMT and PWV average group were higher than low-ARR,high-ARR eGFR is lower than low-ARR group,the difference statistically significant(P< 0.05).Conclusion: There was negatively correlation between ARR and eGFR,positively correlation between ARR and BNP,PWV,carotid intima-media thickness.In patients with essential hypertension,ARR as an indicator of elevation of aldosterone /renin,could be used as a monitoring indicators or risk factors for atherosclerosis and the decrease of glomerular filtration rate.