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

• Published in: The Journal of pediatrics Vol. 155; no. 2; pp. 170 - 175
• Main Authors: Li, Rongling, MD, PhD, MPH, Richey, Phyllis A., PhD, DiSessa, Thomas G., MD, Alpert, Bruce S., MD, Jones, Deborah P., MD, MS
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 01.08.2009; Elsevier
• Subjects: Adolescent; Aldosterone - blood; Biological and medical sciences; Black or African American; Black People; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Body Mass Index; Child; Creatinine - urine; Cross-Sectional Studies; Female; General aspects; Heart Ventricles - diagnostic imaging; Humans; Male; Medical sciences; Pediatrics; Regression Analysis; Renin - blood; Sex Factors; Sodium - urine; Ultrasonography; White People; ABPM; ARR; LVM; HTN; ABPI; LVMI; LVID; IVS; RAAS; Left ventricular mass index; Left ventricular mass; Left ventricular internal dimension; BP; ABP; Ambulatory blood pressure monitoring; Ambulatory blood pressure; Body mass index; DBP; European American; Diastolic blood pressure index; Blood pressure; Renin-angiotensin-aldosterone system; EA; Posterior wall thickness; Plasma renin activity; BMI; AA; Hypertension; SBP; Systolic blood pressure; Diastolic blood pressure; DBPI; Blood pressure index; PWT; SBPI; Interventricular septal thickness; Systolic blood pressure index; Ambulatory blood pressure index; Aldosterone-to-renin ratio; BPI; PRA; African American; Human; Pediatrics; Enzyme; Steroid hormone; Mineralocorticoid; Aldosterone; Blood; Left ventricle; Mass; Peptidases; Renin; Adrenal hormone; Hydrolases; Arterial pressure; Aspartic endopeptidases; Ratio; Hemodynamics; Ambulatory; Child
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2009.02.029

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/m2.7 ; 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.