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Aldosterone to Renin Ratio in a Primary Care Setting: The Bussolengo Study

Unit of Internal Medicine, Department of Clinical and Experimental Medicine (O.O., F.P., P.G., C.P., R.C.), and Institute of Clinical Chemistry (A.Co.), University of Verona, 37134 Verona, Italy; and General Practitioner (A.Ci., A.M., C.C.) and Service of Epidemiology, Bussolengo Health District (D.S., S.F., G.B.), 37012 Bussolengo, Italy

Address all correspondence and requests for reprints to: Dr. Oliviero Olivieri, Dipartimento Medicina Clinica e Sperimentale, Cattedra di Medicina Interna, Università di Verona, Policlinico Borgo Roma, 37134 Verona, Italy. E-mail: oliviero.olivieri{at}univr.it.

The aim of the study was to evaluate the prevalence of hypertension associated with an elevated aldosterone to renin activity ratio (ARR) in a sample of adults aged 35–74 yr, randomly selected from the population register of the Bussolengo Health District (northern Italy) and representative of the total population of the district. Subjects (n = 1462) were randomly selected from the population register and examined by their general practitioners. Complete data for 1348 individuals were available for final statistical analysis. Apart from verapamil or -blockers, no hypotensive drugs were allowed during the 4 wk before assay. Direct active renin and aldosterone were measured in the plasma of hypertensive patients after 2 h in the upright posture. Of 412 identified hypertensive patients, 287 subjects agreed to give blood (70% response rate). An aldosterone to active renin ratio (AARR) of 32 pg/ml was taken as the cut-off value, equivalent to an ARR of 50 ng/dl/ng/ml·h. An elevated AARR was observed in 32.4% of the hypertensive patients, with increased prevalence in females and in people aged 55 yr or older. As an elevated AARR is frequent in the general hypertensive population, screening should not be limited to the patients referred to specialist units.

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