{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T20:28:09Z","timestamp":1775766489774,"version":"3.50.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T00:00:00Z","timestamp":1645660800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004346","name":"Stiftung Rheinland Pfalz f\u00fcr Innovation","doi-asserted-by":"crossref","award":["AZ 961-386261\/733"],"award-info":[{"award-number":["AZ 961-386261\/733"]}],"id":[{"id":"10.13039\/501100004346","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Initiative Health Economy Rhineland-Palatinate by the Ministry of Health and the Ministry of Economics, Rhineland-Palatinate","award":["AZ.623-1"],"award-info":[{"award-number":["AZ.623-1"]}]},{"name":"Federal Ministry of Education and Research, Germany","award":["BMBF, 01EO1003"],"award-info":[{"award-number":["BMBF, 01EO1003"]}]},{"name":"P.S.W. and T.M. are PI\u2019s of the DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>To investigate the predictive ability of direct plasma renin and aldosterone concentrations as well as their ratio [aldosterone-to-renin (ARR)] for incident hypertension in the general population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>Concentration of renin and aldosterone were measured by a chemiluminescence immunoassay using the fully automated LIAISON\u00ae platform (DiaSorin) among 5362 participants of the population-based Gutenberg Health Study, who were normotensive and had no clinically overt cardiovascular disease at baseline. During a follow-up period of 5 years, 18.6% (n = 996) developed a new-onset hypertension. Comparing extreme quartiles of biomarker distribution, the relative risk (RR) for incident arterial hypertension was found to be 1.58 [95% confidence interval (CI) 1.25\u20132.00; P = 0.00015; Q1 vs. Q4ref] for renin; 1.29 (95% CI 1.05\u20131.59, P = 0.018; Q4 vs. Q1ref) for aldosterone and 1.70 (95% CI 1.33\u20132.12; P &amp;lt; 0.0001; Q4 vs. Q1ref) for ARR after multivariable adjustment in men. In females, only high ARR was independently predictive for incident hypertension over 5 years [RR 1.29 (95% CI 1.04\u20131.62); P = 0.024]. Even in the subgroup of individuals having biomarker concentrations within the reference range, high ARR was predictive for new-onset hypertension in men [RR 1.44 (95% CI 1.13\u20131.83); P = 0.003]. Finally, synergistic effects of co-prevalent obesity and ARR on incident hypertension were also demonstrated, resulting in markedly higher risk estimates as seen for biomarker alone [RR of 2.70 (95% CI 2.05\u20133.6) for Q4 of ARR and having body mass index \u2265 30 kg\/m2 vs. low ARR (Q1ref) and normal weight; P &amp;lt; 0.0001].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Among normotensives from the general population ARR possesses a stronger predictive value for incident hypertension than renin or aldosterone alone. The prediction of arterial hypertension by ARR was even stronger in obese subjects.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cvr\/cvac019","type":"journal-article","created":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T20:19:11Z","timestamp":1645474751000},"page":"294-301","source":"Crossref","is-referenced-by-count":10,"title":["Renin, aldosterone, the aldosterone-to-renin ratio, and incident hypertension among normotensive subjects from the general population"],"prefix":"10.1093","volume":"119","author":[{"given":"Natalie","family":"Arnold","sequence":"first","affiliation":[{"name":"Preventive Cardiology and Preventive Medicine, Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany"},{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Hamburg , Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/Luebeck , Hamburg , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2052-1781","authenticated-orcid":false,"given":"Iris M","family":"Hermanns","sequence":"additional","affiliation":[{"name":"Preventive Cardiology and Preventive Medicine, Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Mainz , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Schulz","sequence":"additional","affiliation":[{"name":"Preventive Cardiology and Preventive Medicine, Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7823-7671","authenticated-orcid":false,"given":"Omar","family":"Hahad","sequence":"additional","affiliation":[{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Mainz , Germany"},{"name":"Department of Cardiology\u2014Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz , Langenbeckstra\u00dfe 1, 55131 Mainz , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5070-7280","authenticated-orcid":false,"given":"Volker H","family":"Schmitt","sequence":"additional","affiliation":[{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Mainz , Germany"},{"name":"Department of Cardiology\u2014Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz , Langenbeckstra\u00dfe 1, 55131 Mainz , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Panova-Noeva","sequence":"additional","affiliation":[{"name":"Preventive Cardiology and Preventive Medicine, Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Mainz , Germany"},{"name":"Center for Thrombosis and Hemostasis, University Medical Center of the Johannes-Gutenberg University Mainz , Mainz , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen H","family":"Prochaska","sequence":"additional","affiliation":[{"name":"Preventive Cardiology and Preventive Medicine, Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Mainz , Germany"},{"name":"Department of Cardiology\u2014Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz , Langenbeckstra\u00dfe 1, 55131 Mainz , Germany"},{"name":"Center for Thrombosis and Hemostasis, University Medical Center of the Johannes-Gutenberg University Mainz , Mainz , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5666-8662","authenticated-orcid":false,"given":"Harald","family":"Binder","sequence":"additional","affiliation":[{"name":"Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany"},{"name":"Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg , Freiburg , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norbert","family":"Pfeiffer","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1743-0042","authenticated-orcid":false,"given":"Manfred","family":"Beutel","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl J","family":"Lackner","sequence":"additional","affiliation":[{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Mainz , Germany"},{"name":"Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5503-4150","authenticated-orcid":false,"given":"Thomas","family":"M\u00fcnzel","sequence":"additional","affiliation":[{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Mainz , Germany"},{"name":"Department of Cardiology\u2014Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz , Langenbeckstra\u00dfe 1, 55131 Mainz , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp S","family":"Wild","sequence":"additional","affiliation":[{"name":"Preventive Cardiology and Preventive Medicine, Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Mainz , Germany"},{"name":"Department of Cardiology\u2014Cardiology I, University Medical Center of the Johannes 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