hypertension is more severe and associated with more severe sequelae in blacks when compared with subjects of caucasian extraction [ 25 ] . studies have also shown that black subjects have lower plasma renin levels [ 68 ] . it is thought that black subjects have inappropriately elevated levels of aldosterone relative to plasma renin activity . the activity of the renin - angiotensin - aldosterone system ( raas ) is thought to be the major contributor to the pathogenesis of hypertension and its sequelae . studies have shown that circulating aldosterone levels within the physiologic range are strongly related to increased risk of cardiovascular mortality , fatal stroke , and sudden cardiac death . it has also been shown that chronic administration of aldosterone in animal models leads to cardiac fibrosis and left ventricular hypertrophy ( lvh ) . subjects with primary aldosteronism have early and more severe development of lvh when compared with subjects with essential hypertension . though previous studies , on predominantly white subjects , had not been conclusive on the relationship between left ventricular mass and aldosterone , very few of these studies have been done on black subjects . this study therefore attempts to determine the relationship between aldosterone levels and left ventricular mass in black subjects with essential hypertension . subjects were newly diagnosed but untreated hypertensive subjects recruited from the clinics of the university college hospital , ibadan ; through community screening exercises ; and from among the staff of the university college hospital , ibadan . subjects with secondary hypertension , diabetes mellitus , symptomatic heart failure , and chronic kidney disease were excluded . informed consent was obtained from each subject , and ethical approval was obtained from the joint institutional review board ( irb ) of the college of medicine , university of ibadan / university college hospital , ibadan , nigeria . no caffeine - containing beverages , alcohol , or smoking was allowed for at least 2  h. subjects were not on any medications prior to sample collection . blood was collected into test tubes on ice after 30 minutes of rest in the supine position . a 24  h collection of urine was made the preceding day in plastic containers containing hcl ( 80  mmol / l final concentration ) . high - performance ( cation exchange ) liquid chromatography ( hplc ) was used to determine the plasma renin , plasma aldosterone . plasma and urinary sodium and potassium concentrations were measured using a flame photometric method . echocardiographic examination was done using a phillip aloka ssd 4000 ( aloka co. ltd . , tokyo , japan ) machine with a 2.55.0  mhz linear array transducer . two experienced physicians performed the echocardiography . in our laboratory , the intraobserver concordance correlation coefficient ranged from 0.76 to 0.98 while that of the interobserver concordance ranged from 0.82 to 0.96 . measurements of lv internal diameter ( lvidd ) , intraventricular septal thickness ( ivstd ) , and posterior wall thickness ( pwtd ) were obtained at end diastole . lv mass ( lvm ) was calculated using the formula published by devereux et al . : 0.8  ( 1.04  ( ( lvidd + pwtd + ivstd)3  lvidd3 ) ) + 0.6 , and lvm was indexed to the allometric power of height . relative wall thickness ( rwt ) was measured at end diastole as the ratio 2(pwt)/lvid . data from continuous variables are presented as mean ( standard deviation ) or as medians with interquartile ranges while categoric data are expressed as percentages . all statistical tests were two - sided and carried out to a significance level ( p ) of 0.05 . student 's t - test for independent groups was used to compare normal continuous data while mann - whitney 's test was used to compare nonnormal data . tertiles of plasma aldosterone were generated and the aldosterone groups were compared with analysis of variance for continuous data , and  test was used for categoric data . pearson correlation analysis was used to determine the correlation between plasma aldosterone and arr and the echocardiographic variables of lv structure . a stepwise linear regression model ( with backward elimination ) table 2 shows the biochemical , hormonal , and echocardiographic parameters of the subjects . plasma sodium and renin were lower in the hypertensive subjects . the left atrial , lv wall dimensions , and lv mass were higher in the hypertensives . the hypertensive subjects frequently had more hypertrophic lv geometric patterns when compared with the normal subjects . there were no differences in the plasma aldosterone levels and the urinary excretion of sodium and potassium . table 3 shows the biochemical , hormonal , and echocardiographic parameters of the subjects according to plasma aldosterone tertiles . there was no univariate association between the parameters of lv structure and the plasma aldosterone and aldosterone - to - renin ratio levels ( table 4 ) . in a multivariate model involving lv mass index and age , sex , body mass index ( bmi ) , aldosterone , plasma renin , pulse pressure , and systolic blood pressure ( sbp ) , only age ( p = 0.008 ) , bmi ( p = 0.046 ) , and systolic blood pressure ( p = 0.001 ) were independently associated with the lv mass index ( r = 0.15 , p < 0.0001 ) . in this group of black african subjects , there was no association of plasma aldosterone with lv mass . also , no gender - specific differences in the relationship of lv mass index with plasma aldosterone were seen . only the age of the subjects , their body mass index , and the level of their blood pressure were associated with lv mass . previous studies on the association between lv mass and circulating aldosterone levels in subjects with essential hypertension had yielded conflicting results . .   found no association between aldosterone levels and lv structure in hypertensive caucasians and nonobese black americans , and vasan et al .   found no relationship between lv mass and serum aldosterone in the framingham cohort . other studies [ 1624 ] had noted associations between lv mass and blood aldosterone levels . these conflicting results could be due to differences in the study populations , that is , presence of other comorbidities such as diabetes mellitus , long - standing hypertension , differences in dietary salt intake , and the role of drugs that could alter the renin - angiotensin - aldosterone system . our study subjects were newly diagnosed and treatment - naive hypertensives ; subjects with elevated blood sugar and diabetes mellitus were excluded and were african subjects living in tropical environment . it is quite probable that significant racial differences exist in the relationship between aldosterone levels and lv mass . had documented a significant association between plasma aldosterone levels and lv posterior wall thickness and relative wall thickness but no relationship between lv mass index and aldosterone in women , while edelmann et al . reported a robust and consistent association between echocardiographic parameters of lv structure and serum aldosterone concentration exclusively in women . these gender differences had been thought to be due to differences in adaptation to pressure overload due to oestrogen signalling in the myocardium . in contrast to these studies , we did not find any gender related differences in the association of lv mass and plasma aldosterone levels . it is also probable that envirnomental and dietary factors play a significant role in the modulation of the effects of the renin - angiotensin - aldosterone system in native black africans . the influence of body mass index on lv mass had been noted in previous studies [ 26 , 27 ] . mul et al .   in their study among subjects with metabolic syndrome suggested that obesity might play a role in the association of lv mass with aldosterone levels . the influence of the level of the blood pressure especially systolic blood pressure [ 2830 ] on lv mass index had been previously described in several studies . this is supported by the findings from this study that shows the independent association of systolic blood pressure with lv mass index . the influence of systolic blood pressure on the development of left ventricular hypertrophy is thought to be a result of an increased end - systolic stress which is mostly related to the systolic blood pressure . this supports observations from previous studies that target organ damage in hypertension increases progressively with age [ 32 , 33 ] . though our patients were newly diagnosed with hypertension , many of the subjects could have had longstanding but undiagnosed hypertension . working in south - west nigeria found that about 42% of their subjects already had left ventricular hypertrophy at diagnosis of their hypertension . our study is limited in that only a single measurement of aldosterone was made and might be insufficient in estimating the daily exposure to aldosterone . the determination of 24  hr urinary aldosterone is better suited for the assessment of daily aldosterone load . in conclusion , in our group of black newly diagnosed hypertensive subjects , we did not find an independent association of lv mass index with plasma aldosterone concentration . further studies relating the 24  hr aldosterone load might be necessary to fully evaluate the association of aldosterone and measures of lv structure .