Objectives: The renin-angiotensin-aldosterone system (RAAS) has been implicated in regulating blood pressure (BP), yet its effects on BP-related phenotypes are not well characterized in the Chinese population.
Methods: Based on 8914 participants from the Hakka Biobank (HKB) cohort of China, regression models, restricted cubic spline (RCS), and subgroup analyses were used to analyze associations of plasma aldosterone concentration (PAC), plasma renin concentration (PRC), and the aldosterone-to-renin ratio (ARR) with multiple BP-related phenotypes.
Results: Multivariable regression models indicated that higher log-PAC and log-ARR, and lower log-PRC, were associated with higher systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure (all P < 0.001). A 1-unit higher log-PAC or lower log-PRC was linked to higher risks of systolic, diastolic, clinic, and systolic-diastolic hypertension, with the odds ratios (ORs) ranging from 1.67 (95% confidence interval [CI], 1.47-1.85) to 6.29 (95% CI, 4.48-8.83); and the OR of a higher log-ARR ranged from 1.66 (95% CI, 1.47-1.86) for systolic-diastolic hypertension to 2.42 (95% CI, 2.14-2.73) for clinic hypertension. Consistent associations were observed in subgroup and sensitivity analyses, as well as the participants with renin-independent aldosteronism compared to those with normal aldosterone concentration or renin-dependent aldosteronism (all P < 0.05). Moreover, RCS model revealed significant non-linear associations between log-PAC, log-PRC and log-ARR with hypertension (all P nonlinearity < 0.05).
Conclusions: Higher PAC and ARR, lower PRC were associated with adverse BP variation and elevated risk of hypertension, especially among participants in the context of renin suppression or autonomous aldosterone secretion.
Keywords: Renin phenotype; aldosterone-to-renin ratio; blood pressure; hypertension.
Copyright © 2025. Published by Elsevier Inc.