Aldosterone-to-
renin ratio (ARR) is used to screen
primary hyperaldosteronism. We investigated the association between ARR and the prevalence of
hypertension using home blood pressure (HBP) measurements in community residents stratified for long-term habitual
dietary sodium intake. We obtained HBP and conventional blood pressure (CBP) data for 514 participants aged ≥35 years not receiving
antihypertensive treatment in the general population of Ohasama (mean age: 59.7±10.8 years; 71.2% women). A standardized method was used to calculate habitual
sodium intake from a food-frequency questionnaire. The prevalence of HBP
hypertension (≥135/85 mmHg) and CBP
hypertension (≥140/90 mmHg) were 12.6 and 20.2%, respectively. The median plasma
renin activity (PRA), plasma
aldosterone concentration (PAC) and ARR were 1.1 ngml(-1)h(-1), 6.4 ng per 100 ml and 5.5 ng per 100 ml per ngml(-1)h(-1), respectively. After adjustment for possible confounding factors, each 1 s.d. increase in logARR was associated with the prevalence of HBP
hypertension (odds ratio 1.37; P=0.04), but not with the prevalence of CBP
hypertension (P=0.2). The association of ARR with HBP
hypertension was strengthened for subjects with high
sodium intake (greater than or equal to the median of 4822 mgday(-1)), whereas it became nonsignificant for those with low
sodium intake (interaction P=0.03). Among subjects with high
sodium intake, HBP hypertensives had significantly lower PRA than normotensives, despite no differences in PAC. In conclusion, relative
aldosterone excess or low-
renin hypertension may have an important role in HBP
hypertension in the general population with high
sodium intake.