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Lee S, Chang JS, Park KS, Koh SB, Kim MY, Lim JS. Sex-specific association of low-renin hypertension with metabolic and musculoskeletal health in Korean older adults. Front Public Health 2024; 12:1250945. [PMID: 38410670 PMCID: PMC10894919 DOI: 10.3389/fpubh.2024.1250945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Low-renin hypertension (LRH) accounts for approximately one-third of patients with hypertension and are more prevalent in women and the older adult population. Previous study has found a link between the renin-angiotensin-aldosterone system (RAAS) and sex hormones. However, there are insufficient data on the relationship between LRH and metabolic or musculoskeletal outcomes in older adults. Methods and materials Among the 343 participants from a population-based cohort study conducted between May 2018 and August 2019, a total of 256 (86 men older than 50 years and 170 postmenopausal women) were included. The presence of LRH was defined as plasma renin activity (PRA) <1 ng/mL/h and systolic blood pressure (BP) ≥130 or diastolic BP ≥80 mmHg based on the 2017 ACC/AHA guidelines. Individuals with missing data, and those who had used medications that could affect PRA within the past six months were excluded. Bone mineral density (BMD), trabecular bone score (TBS), and appendicular lean mass (ALM) index were assessed using dual-energy X-ray absorptiometry; degraded TBS was defined as partially degraded to degraded levels (≤1.350). Muscle function was assessed according to the Asian Working Group for Sarcopenia guidelines. PRA was measured using radioimmunoassay. Results The median age was 66 [61-72] years, and the body mass index (BMI) was 24.7 [23.0-26.4] kg/m2. Individuals with LRH, accounting for 34.8%, had lower diabetes mellitus; more dyslipidemia; and poorer muscle function, BMD, and TBS than those in the non-LRH group. In addition, PRA was positively correlated with C-peptide, HOMA-IR, TBS, and ALM index. After adjusting for covariates including age and BMI, LRH was negatively associated with femur neck T-score (adjusted β = -0.30, 95% CI [-0.55 to -0.05], p = 0.021) and the presence of LRH was significantly associated with degraded TBS in women (adjusted odds ratio = 3.00, 95% CI [1.36-6.58], p = 0.006). Conclusion Our findings suggest that LRH can influence clinical features and metabolic risk in older adults. Notably, LRH in postmenopausal women was linked to lower femur neck T-scores and degraded TBS, indicating sex-specific effects of LRH on bone health. Larger prospective studies are required to elucidate how changes in the RAAS affect metabolic and musculoskeletal outcomes in older adults.
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Affiliation(s)
- Seunghyun Lee
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jae Seung Chang
- Department of Sports Science, Hannam University, Daejeon, Republic of Korea
- Department of Physiology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Kyu-Sang Park
- Department of Physiology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sang-Baek Koh
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Moon Young Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Regeneration Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jung Soo Lim
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Cardoso I, Michalowska J, Larsen SC, Abrahamsen B, Heitmann BL, Händel MN. Lack of Transparency in the Meta-Analyses of Dietary and Urinary Sodium and Bone Mineral Density or Risk of Osteoporosis: A Letter to the Journal. J Am Coll Nutr 2019; 38:746-747. [PMID: 30990773 DOI: 10.1080/07315724.2019.1590250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Isabel Cardoso
- Research Unit for Dietary Studies, Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Joanna Michalowska
- Human Appetite Research Unit, School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Sofus C Larsen
- Research Unit for Dietary Studies, Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Bo Abrahamsen
- Department of Clinical Research, Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Berit L Heitmann
- Research Unit for Dietary Studies, Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Section for General Practise, Department of Public Health, Copenhagen University, Copenhagen, Denmark.,National Institute of Public Health University of Southern Denmark, Copenhagen, Denmark
| | - Mina N Händel
- Research Unit for Dietary Studies, Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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Fatahi S, Namazi N, Larijani B, Azadbakht L. The Association of Dietary and Urinary Sodium With Bone Mineral Density and Risk of Osteoporosis: A Systematic Review and Meta-Analysis. J Am Coll Nutr 2018; 37:522-532. [DOI: 10.1080/07315724.2018.1431161] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Somaye Fatahi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazli Namazi
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Kuipers AL, Kammerer CM, Pratt JH, Bunker CH, Wheeler VW, Patrick AL, Zmuda JM. Association of Circulating Renin and Aldosterone With Osteocalcin and Bone Mineral Density in African Ancestry Families. Hypertension 2016; 67:977-82. [PMID: 26975710 DOI: 10.1161/hypertensionaha.115.06837] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/22/2016] [Indexed: 11/16/2022]
Abstract
Hypertension is associated with accelerated bone loss, and the renin-angiotensin-aldosterone system is a key regulator of blood pressure. Although components of this system are expressed in human bone cells, studies in humans are sparse. Thus, we studied the association of circulating renin and aldosterone with osteocalcin and bone mineral density. We recruited 373 African ancestry family members without regard to health status from 6 probands (mean family size: 62 and relative pairs: 1687). Participants underwent a clinical examination, dual-energy x-ray absorptiometry, and quantitative computed tomographic scans. Renin activity, aldosterone concentration, and osteocalcin were measured in fasting blood samples. Aldosterone/renin ratio was calculated as aldosterone concentration/renin activity. All models were analyzed using pedigree-based variance components methods. Full models included adjustment for age, sex, body composition, comorbidities, lifestyle factors, blood pressure, and antihypertensive medication. Higher renin activity was significantly associated with lower total osteocalcin and with higher trabecular bone mineral density (both P<0.01). There were also significant genetic correlations between renin activity and whole-body bone mineral density. There were no associations with aldosterone concentration in any model and results for aldosterone/renin ratio were similar to those for renin activity. This is the first study to report a significant association between renin activity and a marker of bone turnover and bone mineral density in generally healthy individuals. Also, there is evidence for significant genetic pleiotropy and, thus, there may be a shared biological mechanism underlying both the renin-angiotensin-aldosterone system and bone metabolism that is independent of hypertension.
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Affiliation(s)
- Allison L Kuipers
- From the Departments of Epidemiology (A.L.K., C.H.B., J.M.Z.) and Human Genetics (C.M.K., J.M.Z.), University of Pittsburgh, PA; Department of Medicine, Indiana University School of Medicine, Indianapolis (J.H.P.); and Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago (V.W.W., A.L.P.).
| | - Candace M Kammerer
- From the Departments of Epidemiology (A.L.K., C.H.B., J.M.Z.) and Human Genetics (C.M.K., J.M.Z.), University of Pittsburgh, PA; Department of Medicine, Indiana University School of Medicine, Indianapolis (J.H.P.); and Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago (V.W.W., A.L.P.)
| | - J Howard Pratt
- From the Departments of Epidemiology (A.L.K., C.H.B., J.M.Z.) and Human Genetics (C.M.K., J.M.Z.), University of Pittsburgh, PA; Department of Medicine, Indiana University School of Medicine, Indianapolis (J.H.P.); and Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago (V.W.W., A.L.P.)
| | - Clareann H Bunker
- From the Departments of Epidemiology (A.L.K., C.H.B., J.M.Z.) and Human Genetics (C.M.K., J.M.Z.), University of Pittsburgh, PA; Department of Medicine, Indiana University School of Medicine, Indianapolis (J.H.P.); and Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago (V.W.W., A.L.P.)
| | - Victor W Wheeler
- From the Departments of Epidemiology (A.L.K., C.H.B., J.M.Z.) and Human Genetics (C.M.K., J.M.Z.), University of Pittsburgh, PA; Department of Medicine, Indiana University School of Medicine, Indianapolis (J.H.P.); and Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago (V.W.W., A.L.P.)
| | - Alan L Patrick
- From the Departments of Epidemiology (A.L.K., C.H.B., J.M.Z.) and Human Genetics (C.M.K., J.M.Z.), University of Pittsburgh, PA; Department of Medicine, Indiana University School of Medicine, Indianapolis (J.H.P.); and Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago (V.W.W., A.L.P.)
| | - Joseph M Zmuda
- From the Departments of Epidemiology (A.L.K., C.H.B., J.M.Z.) and Human Genetics (C.M.K., J.M.Z.), University of Pittsburgh, PA; Department of Medicine, Indiana University School of Medicine, Indianapolis (J.H.P.); and Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago (V.W.W., A.L.P.)
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Altun B, Kiykim AA, Seyrantepe V, Usalan C, Arici M, Cağlar M, Erdem Y, Yasavul U, Turgan C, Cağlar S. Association Between Activated Renin Angiotensin System and Bone Formation in Hemodialysis Patients: Is the Bone Mass Genetically Determined by ACE Gene Polymorphism? Ren Fail 2009; 26:425-31. [PMID: 15462112 DOI: 10.1081/jdi-120039830] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Angiotensin II (ang II) receptor subtype I binding sites has been recently demonstrated on bone cell precursors. Ang II stimulates DNA and collagen synthesis in human adult bone cells. The aim of this study is to evaluate the role of renin angiotensin system in the bone metabolism and to address the genetic influence of angiotensin converting enzyme (ACE) gene polymorphism on bone mass in hemodialysis patients. METHODS Forty-eight end-stage renal disease patients (28 male, 20 female mean age 42+/-13 years,) on maintenance hemodialysis were included in the study. Bone mineral density (BMD) was estimated at lumbar spine and T score worse than -1.5 were considered as osteopenia. Serum parathyroid hormone (iPTH) and osteocalcin (OC), bone alkaline phosphatase (bAP) and carboxy terminal propeptide type 1 collagen (PICP) levels were measured as markers of bone metabolism. Plasma renin activity (PRA), serum ACE activity and ACE gene polymorphism (II, ID, DD) were determined. RESULTS Bone mineral density and T score of the hemodialysis patients were 0.92+/-0.17 g/cm2 and -1.36+/-1.50, respectively. Twenty-one patients (43,7%) were osteopenic (T score worse than -1.5) and mean T score of osteopenic patients was -2.72+/-0.72. T score of nonosteopenic group was -0.29+/-0.99. Serum calcium, serum, phosphorus, serum OC, serum bAP, serum PCIP, serum PTH levels were similar in osteopenics and nonosteopenics. No difference was observed in predialysis PRA and in both pre- and postdialysis serum ACE activity of patients in both groups. PRA after hemodialysis in nonosteopenic group was higher than osteopenics (p<0.05). Percent increment in PRA in hemodialysis patients was correlated with T score (R=0.48 p <0.05). Serum ACE activity was positively correlated with serum iPTH (R=0.29, p=0.02), serum OC (R=0.35, p=0.01), serum bAP (R=0.34, p=0.01), serum PCIP (R=0.36, p=0.01). T score (-0.7+/-1.5, vs -1.7+/-1.3 p <0.05) was higher in DD group (n=19) compared to II+ID group (n=29). CONCLUSIONS Association of biochemical and radiological signs of increased bone formation with activated RAS in hemodialysis patients might be an evidence for the involvement of this system in the regulation of bone metabolism.
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Affiliation(s)
- Bülent Altun
- Department of Internal Medicine, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey
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Abstract
Abnormalities in bone and mineral metabolism have a significant impact on morbidity and mortality among patients with end-stage renal disease (ESRD). In addition to confounding environmental factors, genetic susceptibility factors may also influence the occurrence and severity of these abnormalities and account for interindividual variability among patients. Indeed, polymorphisms involving genes of the calcium/parathyroid hormone/calcitriol axis have been associated with bone and mineral metabolism abnormalities. This review summarizes studies involving polymorphisms of candidate genes and their effects on the development of complications related to bone and mineral metabolism abnormalities among patients with ESRD.
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Affiliation(s)
- Sehsuvar Erturk
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey.
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