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Kosaki K, Park J, Matsui M, Sugaya T, Kuro-O M, Saito C, Yamagata K, Maeda S. Elevated urinary angiotensinogen excretion links central and renal hemodynamic alterations. Sci Rep 2023; 13:11518. [PMID: 37460637 PMCID: PMC10352254 DOI: 10.1038/s41598-023-38507-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
Inappropriate activation of intrarenal renin-angiotensin system (RAS) may contribute to the pathogenesis of cardio-renal syndrome (CRS). We aimed to examine the cross-sectional associations of urinary angiotensinogen (AGT) excretion, a biomarker of intrarenal RAS activity, with central (aortic) and renal hemodynamic parameters in middle-aged and older adults, including patients with chronic kidney disease. Aortic and renal hemodynamic parameters were measured using applanation tonometry and duplex ultrasonography in 282 participants. Urinary AGT, liver-type fatty acid-binding protein (L-FABP), and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured for each participant. Multiple linear regression analyses demonstrated that urinary AGT levels were associated with aortic blood pressures, pulsatile measures of renal blood flow, plasma NT-proBNP and urinary L-FABP levels after adjusting for potential covariates, including age, sex, body mass index, estimated glomerular filtration rate (GFR), and medication use. Additionally, when classified based on GFR stages and urinary AGT levels, plasma NT-proBNP and urinary L-FABP levels increased in participants with lower GFR and higher AGT groups. Our findings suggest that urinary AGT excretion is a shared determinant of central (aortic) and renal hemodynamics in middle-aged and older adults, providing clinical evidence for the potential role of intrarenal RAS activity in the development of CRS.
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Affiliation(s)
- Keisei Kosaki
- Institute of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan.
- Advanced Research Initiative for Human High Performance (ARIHHP), University of Tsukuba, Ibaraki, Japan.
| | - Jiyeon Park
- Institute of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Masahiro Matsui
- Institute of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Takeshi Sugaya
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Makoto Kuro-O
- Division of Anti-aging Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Chie Saito
- Department of Nephrology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kunihiro Yamagata
- Department of Nephrology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
- R&D Center for Smart Wellness City Policies, University of Tsukuba, Tokyo, Japan
| | - Seiji Maeda
- Institute of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Xu Y, Rong J, Zhang Z. The emerging role of angiotensinogen in cardiovascular diseases. J Cell Physiol 2020; 236:68-78. [PMID: 32572956 DOI: 10.1002/jcp.29889] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
Abstract
Angiotensinogen (AGT) is the unique precursor of all angiotensin peptides. Many of the basic understandings of AGT in cardiovascular diseases have come from research efforts to define its effects on blood pressure regulation. The development of novel techniques targeting AGT manipulation such as genetic animal models, adeno-associated viral approaches, and antisense oligonucleotides made it possible to deeply investigate the relationship between AGT and cardiovascular diseases. In this brief review, we provide contemporary insights into the emerging role of AGT in cardiovascular diseases. In light of the recent progress, we emphasize some newly recognized features and mechanisms of AGT in heart failure, hypertension, atherosclerosis, and cardiovascular risk factors.
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Affiliation(s)
- Yinchuan Xu
- Department of Cardiology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jiabing Rong
- Department of Cardiology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhaocai Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Nishiyama A, Kobori H. Independent regulation of renin-angiotensin-aldosterone system in the kidney. Clin Exp Nephrol 2018; 22:1231-1239. [PMID: 29600408 PMCID: PMC6163102 DOI: 10.1007/s10157-018-1567-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 03/21/2018] [Indexed: 01/13/2023]
Abstract
Renin-angiotensin-aldosterone system (RAAS) plays important roles in regulating renal hemodynamics and functions, as well as in the pathophysiology of hypertension and renal disease. In the kidney, angiotensin II (Ang II) production is controlled by independent multiple mechanisms. Ang II is compartmentalized in the renal interstitial fluid with much higher concentrations than those existing in the circulation. Inappropriate activation of the intrarenal RAAS is an important contributor to the pathogenesis of hypertension and renal injury. It has been revealed that intrarenal Ang II levels are predominantly regulated by angiotensinogen and therefore, urinary angiotensinogen could be a biomarker for intrarenal Ang II generation. In addition, recent studies have demonstrated that aldosterone contributes to the progression of renal injury via direct actions on glomerular podocytes, mesangial cells, proximal tubular cells and tubulo-interstitial fibroblasts through the activation of locally expressed mineralocorticoid receptor. Thus, it now appears that intrarenal RAAS is independently regulated and its inappropriate activation contributes to the pathogenesis of the development of hypertension and renal disease. This short review article will focus on the independent regulation of the intrarenal RAAS with an emphasis on the specific role of angiotensinogen.
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Affiliation(s)
- Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Hiroyuki Kobori
- Departments of Pharmacology and Nephrology, Faculty of Medicine, International University of Health and Welfare, Narita, Japan
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Mizushige T, Kobori H, Hitomi H, Nishijima Y, Tomoda F, Morimoto S, Kohno M, Nishiyama A. Urinary Angiotensinogen Could Be a Prognostic Marker of the Renoprotection of Olmesartan in Metabolic Syndrome Patients. Int J Mol Sci 2016; 17:E1800. [PMID: 27801805 PMCID: PMC5133801 DOI: 10.3390/ijms17111800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/16/2016] [Accepted: 08/19/2016] [Indexed: 01/07/2023] Open
Abstract
This study was performed to demonstrate urinary angiotensinogen as a potential prognostic marker of the albuminuria reduction effects of olmesartan in patients with metabolic syndrome. In 24 patients (eight women, 57.88 ± 2.00 years), 5-40 mg/day of olmesartan were given. Urinary concentrations of albumin and angiotensinogen (normalized by urinary concentrations of creatinine) and plasma renin activity were measured before and after the 12- and 24-week marks of olmesartan treatment. Olmesartan treatment increased plasma renin activity and decreased urinary albumin and urinary angiotensinogen significantly (p < 0.05). Based on the % change in urinary albumin, patients were divided into two groups, responders (<-50%) and non-responders (≥-50%), and a logistic analysis of urinary angiotensinogen before treatment showed the area under the curve as 0.694. When the cutoff value of urinary angiotensinogen before the treatment of 13.9 µg/g Cr was used, the maximum Youden index (0.500, specificity: 11/12 = 91.7% and sensitivity: 7/12 = 58.3%) was obtained. When all patients were re-divided into two groups, those with higher values of urinary angiotensinogen before the treatment (Group H, n = 16) and those with lower values, Group H showed significantly decreased urinary albumin (p < 0.05). Therefore, urinary angiotensinogen could be a prognostic marker of the albuminuria reduction effects of olmesartan in patients with metabolic syndrome.
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Affiliation(s)
- Tomoko Mizushige
- Department of Pharmacology, Kagawa University School of Medicine, Kagawa 761-0793, Japan.
| | - Hiroyuki Kobori
- Department of Pharmacology, Kagawa University School of Medicine, Kagawa 761-0793, Japan.
- Departments of Pharmacology and of Nephrology, School of Medicine, International University of Health and Welfare, Tokyo 107-0062, Japan.
- Departments of Physiology and of Medicine, Tulane University Health Sciences Center, New Orleans, LA 70112, USA.
| | - Hirofumi Hitomi
- Department of Pharmacology, Kagawa University School of Medicine, Kagawa 761-0793, Japan.
| | - Yoko Nishijima
- Department of Medicine, Kagawa University School of Medicine, Kagawa 761-0793, Japan.
| | - Fumihiro Tomoda
- The Second Department of Internal Medicine, Toyama University School of Medicine, Toyama 930-0194, Japan.
| | - Satoshi Morimoto
- The Second Department of Internal Medicine, Kansai Medical University, Osaka 573-1010, Japan.
| | - Masakazu Kohno
- Department of Medicine, Kagawa University School of Medicine, Kagawa 761-0793, Japan.
| | - Akira Nishiyama
- Department of Pharmacology, Kagawa University School of Medicine, Kagawa 761-0793, Japan.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on the current knowledge regarding the role of the intrarenal rennin-angiotensin system (RAS) in the regulation of glomerular function including glomerular dynamics and filtration rate, glomerular permeability and structural alterations during chronic increases in intrarenal angiotensin (Ang) II. RECENT FINDINGS Recent studies have continued to delineate the complex interactions among the various RAS components that participate in regulating glomerular function. Although Ang II acting on AT1 receptors remains as the predominant influence on glomerular dynamics, some of these effects are indirectly mediated by Ang II modulating the sensitivity of the macula densa tubuloglomerular feedback mechanism as well as the more recently described feedback mechanism from the connecting tubule. Interestingly, the actions of Ang II on these systems cause opposite effects on glomerular function demonstrating the complexities associated with the influences of Ang II on glomerular function. When chronically elevated, Ang II also stimulates and/or interacts with other factors, including reactive oxygen species, cytokines and growth factors and other hormones or paracrine agents, to elicit structural alterations. SUMMARY Recent studies have provided further evidence for the presence of many components of the RAS in glomerular structures, which supports the importance of locally produced angiotensin peptides to regulate glomerular haemodynamics, filtration rate and macromolecular permeability and contribute to fibrosis and glomerular injury when inappropriately augmented.
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Is blood pressure load associated, independently of blood pressure level, with target organ damage? J Hypertens 2014; 31:1812-8. [PMID: 23743810 DOI: 10.1097/hjh.0b013e3283624f9b] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Blood pressure (BP) load, defined as the percentage of abnormally elevated BP readings, is usually provided on the report of ambulatory BP monitoring. However, the usefulness of BP load is still uncertain. In the present study, we examined whether BP load would be associated, independently of BP level, with target organ damage. METHODS We recruited 869 individuals (430 men, mean age 51 years) who were referred for 24-h ambulatory BP monitoring and were off antihypertensive medication for at least 2 weeks. BP load was defined as the percentage of daytime and nighttime SBP/DBP readings at least 135/85 and at least 120/70 mmHg, respectively. Brachial-ankle pulse wave velocity (baPWV) and carotid-femoral pulse wave velocity (cfPWV), left ventricular mass index (LVMI) and urinary albumin-to-creatinine ratio (ACR) were determined as measures of target organ damage. RESULTS SBP and DBP load had a skewed distribution (P<0.001). In multivariate-adjusted categorical analyses, baPWV (13.8, 14.6 and 15.6 m/s), cfPWV (7.4, 7.7 and 8.4 m/s), LVMI (90.1, 94.8 and 100.7 g/m) and ACR (0.47, 0.58 and 0.77 mg/mmol) all increased from tertiles 1-3 of SBP load (P<0.001). However, these differences became nonsignificant (P ≥ 0.16) after additionally adjusted for 24-h SBP level. In a continuous analysis in individuals with a BP load greater than zero (n=838), adding the logarithmically transformed SBP load did not improve the fit of models relating measures of target organ damage to SBP level (P ≥ 0.14), except for cfPWV (P=0.01) that was however negatively associated with BP load. Analyses on DBP load produced similar results. CONCLUSION BP load was associated with target organ damage, but not independently of BP level.
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Michel FS, Norton GR, Maseko MJ, Majane OHI, Sareli P, Woodiwiss AJ. Urinary angiotensinogen excretion is associated with blood pressure independent of the circulating renin-angiotensin system in a group of african ancestry. Hypertension 2014; 64:149-56. [PMID: 24777983 DOI: 10.1161/hypertensionaha.114.03336] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Although the circulating renin-angiotensin system (RAS) is suppressed in salt-sensitive populations, the role of the intrarenal RAS in blood pressure (BP) control in these groups independent of the circulating RAS is uncertain. We evaluated the relationship between 24-hour urinary angiotensinogen excretion and either office (mean of 5 measurements; n=425) or 24-hour ambulatory (n=340) BP independent of the circulating RAS in a community-based sample of African descent that had never received antihypertensive drug therapy. Circulating RAS activity was determined from plasma renin and angiotensinogen and serum aldosterone concentrations. Urinary angiotensinogen to creatinine ratio (angiotensinogen/creat) was correlated with plasma angiotensinogen concentrations (P<0.0005) but not with indexes of salt intake. However, urinary angiotensinogen/creat was independently associated with office systolic BP (partial r=0.16; P<0.001), whereas plasma angiotensinogen (partial r=0.07; P=0.14) was not independently associated with office systolic BP. Urinary angiotensinogen/creat was also associated with 24-hour systolic BP (partial r=0.11; P<0.05). The relationships between urinary angiotensinogen/creat and BP survived further adjustments for plasma angiotensinogen and serum aldosterone concentrations, plasma renin concentrations, estimated glomerular filtration rate, urinary Na(+)/K(+), or 24-hour urinary Na(+) excretion rates (P<0.005 for all). Participants with the highest compared with the lowest quartile of urinary angiotensinogen/creat showed an 8.2-mm Hg higher office (P<0.005) and 4.6-mm Hg higher 24-hour (P=0.01) systolic BP. In conclusion, independent of the systemic RAS, including plasma angiotensinogen concentrations, urinary angiotensinogen excretion is associated with BP in a salt-sensitive, low-renin group of African descent. These data lend further support for a role of the RAS in BP control in salt-sensitive groups of African ancestry.
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Affiliation(s)
- Frederic S Michel
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Muzi J Maseko
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Olebogeng H I Majane
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinhas Sareli
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Kurultak I, Sengul S, Kocak S, Erdogmus S, Calayoglu R, Mescigil P, Keven K, Erturk S, Erbay B, Duman N. Urinary angiotensinogen, related factors and clinical implications in normotensive autosomal dominant polycystic kidney disease patients. Ren Fail 2014; 36:717-21. [DOI: 10.3109/0886022x.2014.890857] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Yilmaz Z, Yildirim T, Yilmaz R, Aybal-Kutlugun A, Altun B, Kucukozkan T, Erdem Y. Association between urinary angiotensinogen, hypertension and proteinuria in pregnant women with preeclampsia. J Renin Angiotensin Aldosterone Syst 2014; 16:514-20. [PMID: 24532824 DOI: 10.1177/1470320313510585] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 09/25/2013] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Preeclampsia is a life-threatening disorder of pregnancy. The pathogenic mechanisms of preeclampsia remain uncertain. The aim of this study is to investigate the relation between urinary angiotensinogen (UAGT) levels, an indicator of local renin-angiotensin system (RAS) activity in the kidney, and blood pressure and urinary protein excretion in preeclampsia. MATERIALS AND METHODS For this study, 90 women aged between 20-39 years were recruited. Spot urine samples were collected to measure urinary angiotensinogen/creatinine ratio (UAGT/UCre). Log(UAGT/UCre) was compared in pregnancies with and without preeclampsia and non-pregnant controls. Factors affecting log(UAGT/UCre) in pregnancies were also investigated. RESULTS In all pregnancies log(UAGT/UCre) levels were significantly higher than in non-pregnant controls (0.58±0.19 vs. 0.33±0.14, respectively, p=0.002). However, log(UAGT/UCre) levels in pregnancies with preeclampsia were slightly lower than in normal pregnancies (0.52±0.18 vs. 0.64±0.19, respectively, p=0.012). Log(UAGT/UCre) levels were correlated positively with blood pressure and proteinuria in pregnancies with preeclampsia. However, log(UAGT/UCre) levels were not correlated with age, height, body weight, gestational age, body mass index, and serum creatinine. CONCLUSION This study showed that elevated local RAS activity in kidney was correlated with high blood pressure and proteinuria in preeclampsia. Local RAS activation in the kidneys may be one of the contributing factors in the development of preeclampsia.
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Affiliation(s)
- Z Yilmaz
- Dr. Sami Ulus Women's Health Teaching and Research Hospital Obstetrics and Gynecology Department, Ankara, Turkey
| | - T Yildirim
- Hacettepe University Medical Faculty Nephrology Department, Ankara, Turkey
| | - R Yilmaz
- Hacettepe University Medical Faculty Nephrology Department, Ankara, Turkey
| | - A Aybal-Kutlugun
- Hacettepe University Medical Faculty Nephrology Department, Ankara, Turkey
| | - B Altun
- Hacettepe University Medical Faculty Nephrology Department, Ankara, Turkey
| | - T Kucukozkan
- Dr. Sami Ulus Women's Health Teaching and Research Hospital Obstetrics and Gynecology Department, Ankara, Turkey
| | - Y Erdem
- Hacettepe University Medical Faculty Nephrology Department, Ankara, Turkey
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Chen CT, Li Y, Zhang J, Wang Y, Ling HW, Chen KM, Gao PJ, Zhu DL. Association Between Ambulatory Systolic Blood Pressure During the Day and Asymptomatic Intracranial Arterial Stenosis. Hypertension 2014; 63:61-7. [DOI: 10.1161/hypertensionaha.113.01838] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chao-Ting Chen
- From the State Key Laboratory of Medical Genomics, Department of Hypertension (C.-T.C., J.Z., P.-J.G., D.-L.Z.) and Department of Radiology (H.-W.L., K.-M.C.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; and Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Shanghai, China (C.-T.C., Y.L., Y.W., P.-J.G., D.-L.Z.)
| | - Yan Li
- From the State Key Laboratory of Medical Genomics, Department of Hypertension (C.-T.C., J.Z., P.-J.G., D.-L.Z.) and Department of Radiology (H.-W.L., K.-M.C.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; and Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Shanghai, China (C.-T.C., Y.L., Y.W., P.-J.G., D.-L.Z.)
| | - Jin Zhang
- From the State Key Laboratory of Medical Genomics, Department of Hypertension (C.-T.C., J.Z., P.-J.G., D.-L.Z.) and Department of Radiology (H.-W.L., K.-M.C.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; and Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Shanghai, China (C.-T.C., Y.L., Y.W., P.-J.G., D.-L.Z.)
| | - Yan Wang
- From the State Key Laboratory of Medical Genomics, Department of Hypertension (C.-T.C., J.Z., P.-J.G., D.-L.Z.) and Department of Radiology (H.-W.L., K.-M.C.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; and Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Shanghai, China (C.-T.C., Y.L., Y.W., P.-J.G., D.-L.Z.)
| | - Hua-Wei Ling
- From the State Key Laboratory of Medical Genomics, Department of Hypertension (C.-T.C., J.Z., P.-J.G., D.-L.Z.) and Department of Radiology (H.-W.L., K.-M.C.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; and Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Shanghai, China (C.-T.C., Y.L., Y.W., P.-J.G., D.-L.Z.)
| | - Ke-Min Chen
- From the State Key Laboratory of Medical Genomics, Department of Hypertension (C.-T.C., J.Z., P.-J.G., D.-L.Z.) and Department of Radiology (H.-W.L., K.-M.C.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; and Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Shanghai, China (C.-T.C., Y.L., Y.W., P.-J.G., D.-L.Z.)
| | - Ping-Jin Gao
- From the State Key Laboratory of Medical Genomics, Department of Hypertension (C.-T.C., J.Z., P.-J.G., D.-L.Z.) and Department of Radiology (H.-W.L., K.-M.C.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; and Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Shanghai, China (C.-T.C., Y.L., Y.W., P.-J.G., D.-L.Z.)
| | - Ding-Liang Zhu
- From the State Key Laboratory of Medical Genomics, Department of Hypertension (C.-T.C., J.Z., P.-J.G., D.-L.Z.) and Department of Radiology (H.-W.L., K.-M.C.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; and Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Shanghai, China (C.-T.C., Y.L., Y.W., P.-J.G., D.-L.Z.)
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Soltysiak J, Skowronska B, Fichna P, Ostalska-Nowicka D, Stankiewicz W, Lewandowska-Stachowiak M, Lipkowska K, Zachwieja J. Urinary angiotensinogen and urinary sodium are associated with blood pressure in normoalbuminuric children with diabetes. Pediatr Nephrol 2014; 29:2373-8. [PMID: 24880819 PMCID: PMC4212134 DOI: 10.1007/s00467-014-2861-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/02/2014] [Accepted: 05/14/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the association between blood pressure (BP) and urinary angiotensinogen excretion (uAGT) and renal sodium excretion (uNa) in children with type 1 diabetes mellitus (DM1). METHODS The study group consisted of 52 children with DM1 (28 males and 24 females) with albumin/creatinine ratio (ACR) below 30 mg/g and glomerular filtration rate (eGFR) above 90 ml/min/1.73 m(2). BP was assessed by 24-h ambulatory blood pressure monitoring (ABPM). RESULTS The patients showed significantly increased uAGT values with respect to controls (median 0.00 and range 1.76 vs. 0.00 and 0.00 ng/mg, respectively). The significant increase of uAGT was observed even in prehypertensive patients. uAGT concentrations showed positive correlation with systolic and diastolic 24-h BP and with mean arterial pressure (MAP) (r = 0.594). uNa values were negatively correlated with BP parameters, uAGT, ACR and eGFR. CONCLUSIONS An increase in uAGT precedes hypertension (HTN) in normoalbuminuric children with DM1 and may be considered as a new marker of HTN. Decreased sodium excretion seems to be involved in the development of HTN and early renal injury. Both uAGT and uNa are associated with BP in normoalbuminuric diabetic children.
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Affiliation(s)
- Jolanta Soltysiak
- Department of Pediatric Cardiology and Nephrology, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572, Poznan, Poland,
| | - Bogda Skowronska
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Fichna
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | - Danuta Ostalska-Nowicka
- Department of Pediatric Cardiology and Nephrology, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznan, Poland
| | - Witold Stankiewicz
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | - Maria Lewandowska-Stachowiak
- Department of Pediatric Cardiology and Nephrology, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznan, Poland
| | - Katarzyna Lipkowska
- Department of Pediatric Cardiology and Nephrology, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznan, Poland
| | - Jacek Zachwieja
- Department of Pediatric Cardiology and Nephrology, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznan, Poland
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Wei FF, Li Y, Zhang L, Xu TY, Ding FH, Staessen JA, Wang JG. Association of target organ damage with 24-hour systolic and diastolic blood pressure levels and hypertension subtypes in untreated Chinese. Hypertension 2013; 63:222-8. [PMID: 24246384 DOI: 10.1161/hypertensionaha.113.01940] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The association of target organ damage with 24-hour systolic and diastolic blood pressure levels and ambulatory hypertension subtypes has not yet been examined in untreated Chinese patients. We measured left ventricular mass index by echocardiography (n=619), the urinary albumin:creatinine ratio (n=1047), and aortic pulse wave velocity by tonometry (n=1013) in 1047 untreated subjects (mean age, 50.6 years; 48.9% women). Normotension was a 24-hour systolic/diastolic blood pressure <130/<80 mm Hg. Hypertension subtypes were isolated diastolic hypertension and mixed systolic plus diastolic hypertension. We assessed associations of interest by multivariable-adjusted linear models. Using normotension as reference, mixed hypertension was associated with higher (P≤0.003) left ventricular mass index (+4.31 g/m(2)), urinary albumin:creatinine ratio (+1.63 mg/mmol), and pulse wave velocity (+0.76 m/s); and isolated diastolic hypertension was associated with similar left ventricular mass index and pulse wave velocity (P≥0.39), but higher urinary albumin:creatinine ratio (+1.24 mg/mmol; P=0.002). In younger participants (<55 years), the mutually independent effect sizes associated with 1 SD increases in 24-hour systolic/diastolic blood pressure were +3.31/-0.36 g/m(2) (P=0.009/0.79) for left ventricular mass index, +1.15/+1.14 mg/mmol (P=0.02/0.04) for the urinary albumin:creatinine ratio, and +0.54/-0.05 m/s (P<0.001/0.54) for pulse wave velocity. In older participants, these estimates were +3.58/+0.30 g/m(2) (P=0.045/0.88), +1.23/+1.05 mg/mmol (P=0.002/0.54), and +0.76/-0.49 m/s (P<0.001/<0.001), respectively. In conclusion, 24-hour systolic blood pressure and mixed hypertension are major determinants of target organ damage irrespective of age and target organ, whereas 24-hour diastolic blood pressure and isolated diastolic hypertension only relate to the urinary albumin:creatinine ratio below middle age.
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Affiliation(s)
- Fang-Fei Wei
- Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine Ruijin 2nd Rd, 197 Shanghai 200025 China.
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The renal angiotensin system does not reveal its secrets with a cross-sectional analysis of urinary angiotensinogen levels. J Hypertens 2013; 31:840. [PMID: 23466894 DOI: 10.1097/hjh.0b013e32835eb599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zou J, Li Y, Yan CH, Wei FF, Zhang L, Wang JG. Blood pressure in relation to interactions between sodium dietary intake and renal handling. Hypertension 2013; 62:719-25. [PMID: 23959555 DOI: 10.1161/hypertensionaha.111.00776] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is abundant evidence that sodium intake is related to blood pressure. However, the relationship varies between individuals and is probably determined by renal sodium handling. We investigated clinic and ambulatory blood pressure in relation to interactions between sodium dietary intake and renal handling, as assessed by 24-hour urinary sodium excretion and endogenous lithium clearance, respectively. We calculated fractional excretion of lithium and fractional distal reabsorption rate of sodium, as markers of proximal and distal sodium handling, respectively. The 766 subjects included 379 men and 478 ambulatory hypertensive patients. They were never treated (n=697) or did not take antihypertensive medication for ≥2 weeks (n=69). In adjusted analyses, none of the associations of urinary sodium excretion, fractional excretion of lithium, and fractional distal reabsorption rate of sodium with clinic or ambulatory blood pressure were statistically significant (P≥0.09). However, there was significant (P=0.01) interaction between urinary sodium excretion and fractional excretion of lithium in relation to nighttime diastolic blood pressure. In tertile 3 but not tertiles 1 and 2 of fractional excretion of lithium, nighttime diastolic pressure was positively associated with urinary sodium excretion (P=0.03). However, nighttime diastolic pressure was higher in tertile 1 than tertile 3 of fractional excretion of lithium (+2.0 mm Hg; P=0.01), especially in the bottom tertile of urinary sodium excretion (+4.9 mm Hg; P<0.001). Similar trends were observed for nighttime systolic pressure and clinic and 24-hour diastolic pressure. In conclusion, sodium dietary intake and proximal tubular handling interact to be associated with blood pressure.
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Affiliation(s)
- Jun Zou
- The Shanghai Institute of Hypertension, Ruijin 2nd Rd 197, Shanghai 200025, China.
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The renal angiotensin system does not reveal its secrets with a cross-sectional analysis of urinary angiotensinogen levels. J Hypertens 2013; 31:840-1. [DOI: 10.1097/hjh.0b013e32835eb5a9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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