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Abstract: TH-PO211

Associations Between Urine Sodium and Potassium Level, Elevated Arterial Stiffness, and Hypertension in a Population-Based Study: A Mediation Analysis

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical


  • Fan, Xiaohong, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
  • Ma, Jie, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China

The urinary sodium-potassium ratio (Na-K ratio) has recently been regarded as another hypertension indicator. The current study aims to assess the association of urine sodium and potassium level with elevated arterial stiffness and investigate how this association is mediated via blood pressure.


We performed a cross-sectional study of 10,281 participants in rural China. First void morning urine was collected to detect urine creatinine(Cr), sodium(Na), and potassium(K) levels. All subjects underwent brachial-ankle pulse wave velocity (baPWV) measurement to estimate arterial stiffness. Hypertension was defined as a systolic BP≥140mmHg or diastolic BP≥90mmHg, a self-reported history of hypertension, or the use of antihypertensive medications in the past three months. We analyzed the direct and indirect effects of urine Na-K ratio, Na-Cr ratio, and K-Cr ratio on elevated arterial stiffness (baPWV>=18 m/s) by hypertension in a mediation framework. Analyses were performed with SAS 9.4 (SAS Institute Inc, Cary, NC) and R version 4.0.2.


The mean age of the study population was 55.4±10.0 years; 47.1% were males. Study findings indicated a significant direct association between urine Na-K ratio and elevated baPWV(OR= 1.07; 95% CI, 1.02–1.11). A significant indirect association was also observed between urine Na-K ratio and elevated baPWV (OR= 1.04; 95% CI, 1.03–1.05), indicating that 59.2% of the association of urine Na-K ratio with elevated baPWV was mediated by hypertension. Hypertension accounted for 30.3% of the association between urine Na-Cr ratio and elevated baPWV(direct association: OR= 1.09; 95% CI, 1.05–1.14; indirect association: OR= 1.03; 95% CI, 1.02–1.04). Though, we found a significant direct association between urine K-Cr ratio and elevated baPWV(OR= 1.05; 95% CI, 1.00–1.09), which was not mediated by hypertension (indirect association: OR= 0.98; 95% CI, 0.97–0.99).


Three-fifth of the association of urine Na-K ratio with elevated arterial stiffness may be accounted for hypertension. The urine Na-K ratio is a valuable marker of hypertension and high arterial stiffness risk.