High plasma aldosterone and low renin predict blood pressure increase and hypertension in middle-aged Caucasian populations

Plasma aldosterone and renin levels have been associated with blood pressure increase and 3-4 year incidence of hypertension in a middle-aged North American community in Framingham. To confirm these findings in a different population, a nested case-control study was performed in a national sample of 1984 French non-hypertensive volunteers aged 45-64 year and followed for 5 years. Cases and controls (individuals becoming hypertensive or remaining non-hypertensive on follow-up) were individually matched on sex, diastolic and systolic pressures at baseline. Multivariable regression models show that plasma aldosterone and renin are respectively positively and negatively associated with the increase in systolic pressure (P = 0.01 and 0.001) and the risk of hypertension (22% increase and 16% decrease per s.d. increment in the log, P = 0.04 and 0.07). These associations are mostly observed in the lowest tertiles of dietary sodium and potassium intakes where plasma aldosterone is positively associated with the increase in systolic pressure (P = 0.01 and 0.08) and the risk of hypertension (59 and 69% increase per s.d. increment in the log, P = 0.02 and 0.01), whereas plasma renin is negatively associated with the increase in systolic pressure (P = 0.0004 and 0.004) and the risk of hypertension (31 and 28% decrease per s.d. increment in the log, P = 0.03 and 0.05). These results reinforce the hypothesis that high plasma aldosterone and low plasma renin levels precede blood pressure increase and the occurrence of hypertension in middle-aged Caucasian populations.