Aldosterone-to-renin ratio and nocturnal blood pressure decline in a general population: The Ohasama study

Michihiro Satoh, Masahiro Kikuya, Takayoshi Ohkubo, Takefumi Mori, Hirohito Metoki, Takanao Hashimoto, Azusa Hara, Megumi T. Utsugi, Takuo Hirose, Taku Obara, Ryusuke Inoue, Kei Asayama, Atsuhiro Kanno, Kazuhito Totsune, Haruhisa Hoshi, Hiroshi Satoh, Yutaka Imai

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


Background: Aldosterone-to-renin ratio (ARR) is an index for inappropriate aldosterone activity and salt sensitivity. We previously reported that elevated ARR might be associated with salt-sensitive hypertension. Because salt-sensitive hypertensive patients are reported to show a diminished nocturnal decline in blood pressure, we hypothesized that high ARR may be associated with diminished nocturnal decline in blood pressure (generally referred to as a 'nondipping' pattern), especially in individuals with high sodium intake. Methods: This study tested this hypothesis in 184 participants aged at least 55 years not receiving antihypertensive treatment in a general Japanese population (age: 67.6±6.9 years; 71.7% women). Results: Ambulatory blood pressure monitoring identified 63 (34.2%) participants with a nondipping pattern (nocturnal decline of SBP <10%). The median plasma renin activity (PRA), plasma aldosterone concentration (PAC), and ARR were 0.8 ng/ml per h, 8.3 ng/dl, and 8.7 ng/dl per (ng/ml per h), respectively. After adjustment for possible confounding factors, each 1SD increase in logARR was associated with the prevalence of nondipping pattern (odds ratio, 1.95; P=0.002). This association was observed in individuals in the highest tertile of 24-h urinary sodium excretion estimated from spot urine data (e24-hUNa; ≥179.6 mEq/day; P=0.01) but disappeared in those in the lowest tertile of e24-hUNa (<147.9 mEq/day; P=0.6). In those in the highest tertile of e24-hUNa, PRA was significantly lower in nondippers than in dippers (0.49 vs. 0.85 ng/ml per h) despite no differences in PAC. Conclusion: These results suggest that relative aldosterone excess might be related to a nondipping pattern of blood pressure, especially in individuals with high sodium intake.

Original languageEnglish
Pages (from-to)1940-1947
Number of pages8
JournalJournal of hypertension
Issue number10
Publication statusPublished - 2011 Oct
Externally publishedYes


  • Aldosterone-to-renin ratio
  • Nondipping pattern
  • Relative aldosterone excess
  • Salt-sensitive hypertension
  • Sodium intake

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Aldosterone-to-renin ratio and nocturnal blood pressure decline in a general population: The Ohasama study'. Together they form a unique fingerprint.

Cite this