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Renin-to-Aldosterone Ratio Is Associated with Ambulatory Blood Pressure Levels and Control in Treated Hypertensive

Matteo Landolfo1,2, Francesco Spannella3,4, Alessandro Gezzi3

  • 1Clinical and Molecular Sciences Department, "Politecnica delle Marche" University, Ancona, Italy, m.landolfo@univpm.it.

Obesity Facts
|May 6, 2026
PubMed

Insights

The renin-to-aldosterone ratio (RAR) is linked to better blood pressure control in treated hypertension, irrespective of obesity. Higher RAR, driven by renin levels, indicates improved outcomes in patients on renin-angiotensin system inhibitors.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Pharmacology

Background:

  • Hypertension management involves combination therapy modulating the Renin-Angiotensin-Aldosterone System (RAAS).
  • Excess adiposity can disrupt RAAS, leading to blood pressure variability and treatment resistance.
  • The study investigates the renin-to-aldosterone ratio (RAR) in overweight/obese hypertensive patients.

Purpose of the Study:

  • To evaluate the association between RAR and ambulatory blood pressure monitoring (ABPM) in treated hypertensive patients with overweight (OW) or obesity (OB).
  • To determine if central obesity affects the relationship between RAR and blood pressure control.

Main Methods:

  • Cross-sectional study of 97 OW/OB hypertensive adults and 97 normal-weight controls on stable therapy (RASi + TZD and/or CCB).
  • 24-hour ABPM, direct renin concentration (DRC), and plasma aldosterone concentration (PAC) measurements were performed.
  • RAR calculated as DRC/PAC, with values normalized using natural logarithm (Ln).

Main Results:

  • Higher LnRAR and LnDRC correlated with greater odds of achieving 24-hour, daytime, and night-time blood pressure control in both OW/OB and normal-weight groups.
  • LnRAR and LnDRC were inversely associated with ABP levels in controls, but not in OW/OB patients.
  • Patients with controlled ABP exhibited higher median LnRAR and LnDRC values than those with uncontrolled ABP, irrespective of weight status.

Conclusions:

  • RAR, influenced by higher DRC levels, demonstrates a mechanism-based association with blood pressure control in treated hypertension.
  • This association persists regardless of the presence of visceral obesity.
  • The findings suggest a pharmacologic response to RAS inhibition contributes to RAR's role in blood pressure management.
Abstract

Keywords:
AldosteroneAmbulatory blood pressureObesityOverweightRenin

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