Key result
Higher renin-to-aldosterone ratio linked to ~74% greater odds of 24-hour ABPM control in overweight/obese patients.
Why the study?
Excess adiposity may induce renin-aldosterone axis dysregulation and contribute to blood pressure variability and treatment resistance in treated hypertensive patients.
Is the renin-to-aldosterone ratio associated with ambulatory blood pressure control in treated hypertensive patients with overweight or obesity?
Cross-Sectional (n=194)
Is the renin-to-aldosterone ratio associated with ambulatory blood pressure control in treated hypertensive patients with overweight or obesity?
Effect estimate: OR 1.74 (95% CI 1.25-2.42)
p-value: p=0.001
A higher renin-to-aldosterone ratio is associated with better ambulatory blood pressure control in treated hypertensive patients, regardless of visceral obesity.
Renin-to-aldosterone ratio should not yet guide hypertension treatment; leaves open its utility as biomarker for ambulatory blood pressure control.
Introduction: Combination therapy, including a renin-angiotensin system inhibitor (RASi) and a thiazide diuretic (TZD) or a calcium channel blocker (CCB), is the first-line approach in hypertension management and modulates circulating markers of the Renin-Angiotensin-Aldosterone System (RAAS). Excess adiposity may induce renin-aldosterone axis dysregulation and contribute to blood pressure variability and treatment resistance. This study aimed to evaluate the association between the renin-to-aldosterone ratio (RAR) and ambulatory blood pressure monitoring (ABPM) in treated hypertensive patients with central overweight (OW) or obesity (OB). Methods: In a cross-sectional design, 97 adults with essential hypertension and OW/OB on stable RASi + TZD and/or CCB therapy were matched with 97 normal-weight hypertensive controls. All participants underwent 24-hour ABPM and orthostatic direct renin concentration (DRC) and plasma aldosterone concentration (PAC) measurements. RAR was calculated as the ratio between DRC and PAC. For the analyses values were normalized using natural logarithm (Ln). Results: LnRAR and LnDRC were inversely associated with 24-hour, daytime, and night-time ABP levels in controls, but not in OW/OB patients. However, higher LnRAR and LnDRC values were linked to greater odds of achieving ABP control in both OW/OB and normal-weight for 24h [LnRAR OR 1.74 (1.25-2.42), p=0.001 in OW/OB], daytime, and night-time periods, whereas LnPAC showed no significant associations. Two-way ANOVA confirmed that patients with controlled ABP had higher median LnRAR and LnDRC values than those with uncontrolled ABP, regardless of weight status (p for interaction >0.05). Conclusion: RAR, primarily driven by higher DRC levels and likely linked to a pharmacologic response to RAS inhibition, shows a mechanism-based association with ABP control in treated hypertension, regardless of the presence of visceral obesity.
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Landolfo et al. (2026) conducted a cross-sectional in Essential hypertension with central overweight or obesity (n=194). Renin-to-aldosterone ratio (RAR) vs. Normal-weight hypertensive controls was evaluated on Association between renin-to-aldosterone ratio (RAR) and ambulatory blood pressure monitoring (ABPM) control (OR 1.74, 95% CI 1.25-2.42, p=0.001). Higher natural logarithm of the renin-to-aldosterone ratio was associated with greater odds of achieving 24-hour ambulatory blood pressure control in overweight/obese patients (OR 1.74; 95% CI 1.25-2.42; p=0.001).
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