Elevated Plasma Aldosterone-to-Renin Ratio as a 1 Potential Risk Marker of Adverse Left Ventricular 2 Remodeling: A Cross-Sectional Study 3

Mingjie Xu¹Yushuang Wei²Mingli Li²Zengnan Mo^2*Yan Boteng^2*

• ¹Department of Urology, Hunan University of Medicine General Hospital, Huaihua, China
• ²Guangxi Medical University, Nanning, China

Background: Recent evidence suggested that primary aldosteronism (PA) is the predominant cause of secondary hypertension and is linked to adverse left ventricular (LV) remodeling. However, few studies have investigated the potential associations of aldosterone/renin ratio (ARR), an important parameter for PA screening, with the risk of adverse LV remodeling in Chinese population. This study aimed to investigate the associations of ARR, plasma aldosterone concentration (PAC), and plasma renin concentration (PRC) with adverse LV remodeling in population from Guangxi, China. Methods: The analyzed data was mainly from the First Affiliated Hospital of Guangxi Medical University and the First People's Hospital of Yulin City during the period from September 2022 to March 2024.Included 724 participants (mean age 56.4 ± 14.3 years, 71% with hypertension) who underwent aldosterone-renin testing and echocardiography. Data on demographics, clinical history, and medications (including calcium channel blockers and mineralocorticoid receptor antagonists (MRAs) were collected. We applied generalized linear model (GLM) and multivariable logistic regression to estimate the relationships between ARR, PAC, and PRC with the risk of adverse LV remodeling and left ventricular hypertrophy (LVH), and further explored the dose-response relationship Results:GLM revealed ARR was associated with greater left atrium size, left ventricular end-diastolic diameter, left ventricular mass, and left ventricular mass index. In adjusted multivariable regression analyses, one-SD ARR emerged as a significant predictor of LVH occurrence (OR = 1.531[95%CI,1.041-2.251], P = 0.030), and compared with the first tertile of ARR, the third tertile of ARR has 2.106-fold higher risk of LVH(P-trend < 0.05), especially in participants without mineralocorticoid receptor antagonists (MRA). Furthermore, a significant dose-response relationship was observed between ARR and LVH risk (P overall < 0.001, P non-linear = 0.079. Conclusion: Elevated ARR is associated with an increased risk of adverse LV remodeling, and the presence of LVH may even occur at ARR levels below the clinical standard range, suggesting that ARR could serve as an early indicator of cardiac structural changes. Our results imply that earlier targeted intervention with MRAs may be beneficial. However, this hypothesis requires confirmation in prospective and interventional studies, particularly those assessing the clinical and cost-effectiveness of early MR blockade.