Abstract
Previous studies have reported a positive association between the urinary sodium-to-potassium (Na/K) ratio and hypertension, and multiple measurements of the casual urinary Na/K ratio are more strongly correlated with the 24-h urinary Na/K ratio than a single measurement. Multiple measurements of the urinary Na/K ratio might be more strongly associated with hypertension. We aimed to determine the association between multiple measurements of the casual urinary Na/K ratio and home hypertension compared with a single measurement. A population-based cross-sectional study was performed in Miyagi Prefecture, Japan. Subjects were over 20 years old and participated in the Tohoku Medical Megabank Project Cohort Study. We targeted 3273 subjects who borrowed home blood pressure (HBP) monitors and urinary Na/K ratio monitors for 10 consecutive days. The association between the urinary Na/K ratio and home hypertension (HBP ≥ 135/85 mmHg or under treatment for hypertension) was examined using multiple logistic regression models. To compare the prediction of home hypertension using multiple measurements with that using a single measurement, we calculated the area under the receiver operating characteristic curve (AUROC). Multiple measurements of the urinary Na/K ratio strongly related to home hypertension were better than 1 or 2 days of measurement (adjusted odds ratio of home hypertension per unit increase in urinary Na/K ratio over 6 days: 1.13–1.15). The AUROC of the urinary Na/K ratio measurement for home hypertension was stable after 5 days (AUROC = 0.779). In conclusion, multiple measurements of the urinary Na/K ratio are strongly related to home hypertension. This finding suggests that multiple measurements of the urinary Na/K ratio are useful for evaluating home hypertension.
Highlights
The prevention of hypertension is very important because hypertension leads to serious diseases, such as heart disease and stroke [1]
Few studies have shown whether urinary Na/K ratios from self-monitoring devices are associated with blood pressure (BP) or hypertension in the general population
A previous study reported that an estimated 24-h urinary Na/K ratio from repeated casual urine samples collected yearly for 5 years was positively associated with blood pressure [12]
Summary
The prevention of hypertension is very important because hypertension leads to serious diseases, such as heart disease and stroke [1]. High sodium intake is an established risk factor for hypertension [2,3,4]. It is widely reported that potassium intake is inversely associated with hypertension. The Prospective Urban Rural Epidemiology study showed a positive association between estimated 24-h urinary sodium-to-potassium ratios (Na/K ratios) and both systolic blood pressure (SBP) and diastolic blood pressure (DBP) [5]. The INTERSALT Cooperative Research Group reported that the 24-h urinary Na/K ratio had an even greater effect than sodium or potassium alone on SBP [2]. The 2017 American College of Cardiology/American Heart Association Hypertension Guideline recommends reducing sodium intake and increasing potassium intake to prevent
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