Normotension with decreased plasma renin activity and low serum ionic calcium levels: a prehypertensive state?

We studied the relationships between the renin-angiotensin-aldosterone system and calcium and magnesium levels in both serum and urine in 51 volunteer normotensive subjects, divided into two groups. Group 1 was made up of the 25 subjects whose levels of plasma renin activity were the lowest (1.93 +/- 0.70 ng/ml/hr). Group 2 comprised the 26 subjects with the highest plasma renin activity levels (4.80 +/- 0.84 ng/ml/hr). The following parameters were measured on all subjects: plasma renin activity and plasma and urinary aldosterone levels (by radioimmunoassay), serum ionic calcium levels (by Nova-2), total serum calcium, and serum and urinary magnesium values (by atomic absorption), serum and urinary sodium and potassium levels (by flame photometry), and creatinine clearance. In the group with low plasma renin activity (group 1), our findings included low serum ionic calcium levels (P less than .001); high coefficients of plasma aldosterone/plasma renin activity and urinary aldosterone/plasma renin activity (P less than .001); a significant correlation between the serum ionic calcium level and plasma renin activity (P less than .001); and an inverse correlation between systolic arterial tension and the serum ionic calcium level (P less than .05). These changes were more similar to change described in hypertensive patients with low plasma renin activity than to the findings in group 2 subjects. We speculate that normotensive subjects with low plasma renin activity present significant changes in the relationship between the renin-angiotensin-aldosterone system and sodium and calcium levels, and that this group is at risk for hypertension. A diet low in sodium and high in calcium could be an effective preventive measure.