Blood Aldosterone-to-Renin Ratio, Ambulatory Blood Pressure, and Left Ventricular Mass in Children

Objective

To assess the blood aldosterone-to-renin ratio (ARR) and its relationship to ambulatory blood pressure (ABP) and left ventricular mass (LVM) in children.

Study design

A cross-sectional clinical study was conducted in 102 children (71.6% African American; 62.7% male) ranging in age from 7 to 18 years (mean, 13.6 years; median, 14 years). ABP (24-hour monitoring) was expressed as blood pressure index (BPI; mean blood pressure/95th percentile by sex and height). LVM was measured by echocardiography and expressed as an index (LVMI = g/height [m]^2.7). Regression analyses were used to estimate associations.

Results

African-American children had significantly lower serum aldosterone concentration and plasma renin activity compared with European-American children (aldosterone: 5.9 ng/dL vs 11.4 ng/dL, P < .0001; renin: 1.6 ng/mL/hour vs 2.8 ng/mL/hour, P = .01). However, ARR was not significantly different by race. ARR was not associated with 24-hour ABP but was significantly associated with LVMI (β = 0.4 g/m^2.7; P = .02) after adjustment for the ratio of 24-hour urine Na to creatinine excretion, body mass index z- score, and ABP index.

Conclusions

The data indicated a significant association between ARR and LVMI, but not ABP, in children, suggesting early cardiac remodeling associated with a high ARR.

AA, African American, ABP, Ambulatory blood pressure, ABPI, Ambulatory blood pressure index, ABPM, Ambulatory blood pressure monitoring, ARR, Aldosterone-to-renin ratio, BMI, Body mass index, BP, Blood pressure, BPI, Blood pressure index, DBP, Diastolic blood pressure, DBPI, Diastolic blood pressure index, EA, European American, HTN, Hypertension, IVS, Interventricular septal thickness, LVID, Left ventricular internal dimension, LVM, Left ventricular mass, LVMI, Left ventricular mass index, PRA, Plasma renin activity, PWT, Posterior wall thickness, RAAS, Renin-angiotensin-aldosterone system, SBP, Systolic blood pressure, SBPI, Systolic blood pressure index