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Gideon A, von Känel R, Degroote C, Thomas L, Zuccarella-Hackl C, Wiest R, Wirtz PH. Increased daytime and awakening salivary free aldosterone in essential hypertensive men. Front Cardiovasc Med 2024; 11:1335329. [PMID: 38984356 PMCID: PMC11231427 DOI: 10.3389/fcvm.2024.1335329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/30/2024] [Indexed: 07/11/2024] Open
Abstract
Background While aldosterone plays an important role in blood pressure regulation, its role in essential hypertension (EHT) remains unclear. Here, we systematically investigated the secretion of biologically-active free aldosterone in saliva in response to awakening (AldAR) and during the day (AldDay) in EHT compared to normotensive controls (NT). Methods In 30 men with EHT and 30 age-matched NT, AldAR saliva samples were collected immediately after awakening and 15, 30, 45, and 60 min thereafter and AldDay samples were collected from 08:30-22:00 h on two consecutive days. Results Over the course of the day, men with EHT had higher repeated AldDay levels compared to NT (p = .002) with higher concentrations in the morning hours (p's ≤ .047), a steeper decline over the course of the day (p's ≤ .018), and similar concentrations in the evening (p's ≥ .21). Regarding AldAR, we observed higher concentrations in EHT at awakening (p = .017) and borderline higher concentrations at 15 min (p = .086). No differences were found 30-60 min after awakening (p's ≥ .34). Analyses with repeated and aggregated AldAR levels resulted in borderline significantly higher free aldosterone in EHT (p's ≤ .077). Complementary analyses confirmed linear associations between higher blood pressure and higher AldAR and AldDay levels. Conclusions Our data point to elevated salivary free aldosterone secretion in EHT over the course of the day, particularly in the morning hours. As the free aldosterone fraction is considered biologically active, our data may point to a biological mechanism underlying EHT.
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Affiliation(s)
- Angelina Gideon
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Cathy Degroote
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
| | - Livia Thomas
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roland Wiest
- Support Center of Advanced Neuroimaging, Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Petra H. Wirtz
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Konstanz, Germany
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Couch CA, Fowler LA, Goss AM, Gower BA. Associations of renal sinus fat with blood pressure and ectopic fat in a diverse cohort of adults. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 16:200165. [PMID: 36874041 PMCID: PMC9975207 DOI: 10.1016/j.ijcrp.2022.200165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/04/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
Background Renal sinus fat (RSF) is an ectopic fat depot shown to be associated with visceral adiposity and hypertension in predominantly white populations. The purpose of this analysis is to investigate RSF and associations between RSF and blood pressure in a cohort of African American (AA) and European American (EA) adults. A secondary purpose was to explore risk factors associated with RSF. Methods Participants were 116 A A and EA adult men and women. Ectopic fat depots were assessed with MRI: RSF, intraabdominal adipose tissue (IAAT), intermuscular adipose tissue (IMAT), perimuscular adipose tissue (PMAT), and liver fat. Cardiovascular measures included diastolic blood pressure (DBP), systolic blood pressure (SBP), pulse pressure, mean arterial pressure, and flow mediated dilation. Matsuda index was calculated for insulin sensitivity. Pearson correlations were used to investigate associations of RSF with cardiovascular measures. Multiple linear regression was used to evaluate contributions of RSF on SBP and DBP and to explore factors associated with RSF. Results No difference was observed in RSF between AA and EA participants. RSF was positively associated with DBP in AA participants, but this was not independent of age and sex. Age, male sex, and total body fat were positively associated with RSF in AA participants. Insulin sensitivity was inversely and IAAT and PMAT were positively associated with RSF in EA participants. Conclusions Differential associations of RSF with age, insulin sensitivity, and adipose depots among AA and EA adults suggest unique pathophysiological mechanisms influence RSF deposition, which may contribute to chronic disease etiology and progression.
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Affiliation(s)
- Catharine A. Couch
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lauren A. Fowler
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy M. Goss
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara A. Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Parksook WW, Heydarpour M, Gholami SK, Luther JM, Hopkins PN, Pojoga LH, Williams JS. Salt Sensitivity of Blood Pressure and Aldosterone: Interaction Between the Lysine-specific Demethylase 1 Gene, Sex, and Age. J Clin Endocrinol Metab 2022; 107:1294-1302. [PMID: 35022775 PMCID: PMC9016472 DOI: 10.1210/clinem/dgac011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Indexed: 01/13/2023]
Abstract
CONTEXT Salt sensitivity of blood pressure (SSBP) is associated with increased cardiovascular risk, especially in individuals of African descent, although the underlying mechanisms remain obscure. Lysine-specific demethylase 1 (LSD1) is a salt-sensitive epigenetic regulator associated with SSBP and aldosterone dysfunction. An LSD1 risk allele in humans is associated with SSBP and lower aldosterone levels in hypertensive individuals of African but not European descent. Heterozygous knockout LSD1 mice display SSBP and aldosterone dysregulation, but this effect is modified by age and biological sex. This might explain differences in cardiovascular risk with aging and biological sex in humans. OBJECTIVE This work aims to determine if LSD1 risk allele (rs587618) carriers of African descent display a sex-by-age interaction with SSBP and aldosterone regulation. METHODS We analyzed 297 individuals of African and European descent from the HyperPATH cohort. We performed multiple regression analyses for outcome variables related to SSBP and aldosterone. RESULTS LSD1 risk allele carriers of African (but not European) descent had greater SSBP than nonrisk homozygotes. Female LSD1 risk allele carriers of African descent had greater SSBP, mainly relationship-driven by women with low estrogen (postmenopausal). There was a statistically significant LSD1 genotype-sex interaction in aldosterone response to angiotensin II stimulation in individuals aged 50 years or younger, with female carriers displaying decreased aldosterone responsiveness. CONCLUSION SSBP associated with LSD1 risk allele status is driven by women with a depleted estrogen state. Mechanisms related to a resistance to develop SSBP in females are uncertain but may relate to an estrogen-modulating effect on mineralocorticoid receptor (MR) activation and/or LSD1 epigenetic regulation of the MR.
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Affiliation(s)
- Wasita W Parksook
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
- Department of Medicine (Division of Endocrinology and Metabolism, and Division of General Internal Medicine), Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Mahyar Heydarpour
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Shadi K Gholami
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - James M Luther
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Hypertension Center, Nashville, Tennessee 37232, USA
| | - Paul N Hopkins
- Cardiovascular Genetics Research Unit, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA
| | - Luminita H Pojoga
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Robers MV, Chan C, Vajdi B, Chiong-Rivero H, Martinez A, Burnett ME, Ramanathan M, Amezcua L. Hypertension and hypertension severity in Hispanics/Latinx with MS. Mult Scler 2021; 27:1894-1901. [PMID: 34197237 DOI: 10.1177/13524585211019243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Vascular comorbidities (VCs) including hypertension (HTN) are associated with worse multiple sclerosis (MS) outcomes. HTN is common in Latinx, but the prevalence and relationship with disability are unknown in Latinx with MS. METHODS Latinx (n = 451) from the Alliance for Research in Hispanic MS (ARHMS) seen between 2007 and 2019 were included. HTN, diabetes (DM), hyperlipidemia (HLD), ischemic events, and smoking were considered VC. Blood pressures (BPs) were classified using the American Heart Association (AHA) criteria. Logistic regression determined associations between VC and ambulatory disability accounting for age, sex, and disease duration. RESULTS Medical comorbidities were found in 41.9% and VC in 24.2%. Smoking (13.6%) and HTN (7.3%) were the most common. HTN was the most common over the age of 40 (12.6%). The odds of having severe disability were three times higher for those with HTN (odds ratio [OR], 3.12; 95% confidence interval (CI), 1.37-7.12). Stage II HTN according to AHA also tripled the odds (OR, 2.89; 95%CI, 1.11-7.55). AHA BP confirmed HTN in 27.5% (compared to 7.3% with established diagnosis). CONCLUSION HTN diagnosis and stage II HTN defined by AHA were independently associated with severe ambulatory disability in Latinx with MS. HTN was underdiagnosed. Future studies should assess whether HTN treatment control would prevent disability in MS.
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Affiliation(s)
- Michael V Robers
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA/Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Chan Chan
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Borna Vajdi
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Horacio Chiong-Rivero
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Andrea Martinez
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Margaret E Burnett
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Murali Ramanathan
- Departments of Pharmaceutical Sciences and Neurology, State University of New York, Buffalo, NY, USA
| | - Lilyana Amezcua
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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Joseph JJ, Pohlman NK, Zhao S, Kline D, Brock G, Echouffo-Tcheugui JB, Sims M, Effoe VS, Wu WC, Kalyani RR, Wand GS, Kluwe B, Hsueh WA, Abdalla M, Shimbo D, Golden SH. Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study. Circulation 2021; 143:2355-2366. [PMID: 33605160 PMCID: PMC8789344 DOI: 10.1161/circulationaha.120.050896] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/11/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The renin-angiotensin-aldosterone system (RAAS) is an important driver of blood pressure (BP), but the association of the RAAS with ambulatory BP (ABP) and ABP monitoring phenotypes among African Americans has not been assessed. METHODS ABP and ABP monitoring phenotypes were assessed in 912 Jackson Heart Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analyses were used to analyze the association of aldosterone and PRA with clinic, awake, and asleep systolic BP and diastolic BP (DBP) and ABP monitoring phenotypes, adjusting for important confounders. RESULTS The mean age of participants was 59±11 years and 69% were female. In fully adjusted models, lower log-PRA was associated with higher clinic, awake, and asleep systolic BP and DBP (all P<0.05). A higher log-aldosterone was associated with higher clinic, awake, and asleep DBP (all P<0.05). A 1-unit higher log-PRA was associated with lower odds of daytime hypertension (odds ratio [OR] 0.59 [95% CI, 0.49-0.71]), nocturnal hypertension (OR, 0.68 [95% CI, 0.58-0.79]), daytime and nocturnal hypertension (OR, 0.59 [95% CI, 0.48-0.71]), sustained hypertension (OR, 0.52 [95% CI, 0.39-0.70]), and masked hypertension (OR 0.75 [95% CI, 0.62-0.90]). A 1-unit higher log-aldosterone was associated with higher odds of nocturnal hypertension (OR, 1.38 [95% CI, 1.05-1.81]). Neither PRA nor aldosterone was associated with percent dipping, nondipping BP pattern, or white-coat hypertension. Patterns for aldosterone:renin ratio were similar to patterns for PRA. CONCLUSIONS Suppressed renin activity and higher aldosterone:renin ratios were associated with higher systolic BP and DBP in the office and during the awake and asleep periods as evidenced by ABP monitoring. Higher aldosterone levels were associated with higher DBP, but not systolic BP, in the clinic and during the awake and asleep periods. Further clinical investigation of novel and approved medications that target low renin physiology such as epithelial sodium channel inhibitors and mineralocorticoid receptor antagonists may be paramount in improving hypertension control in African Americans.
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Affiliation(s)
- Joshua J. Joseph
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Neal K. Pohlman
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Songzhu Zhao
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - David Kline
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Guy Brock
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Valery S. Effoe
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Wen-Chih Wu
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gary S. Wand
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bjorn Kluwe
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Willa A. Hsueh
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Marwah Abdalla
- Division of Cardiology, Columbia University, New York, NY, USA
| | - Daichi Shimbo
- Division of Cardiology, Columbia University, New York, NY, USA
| | - Sherita H. Golden
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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Joseph JJ, Zhou X, Zilbermint M, Stratakis CA, Faucz FR, Lodish MB, Berthon A, Wilson JG, Hsueh WA, Golden SH, Lin S. The Association of ARMC5 with the Renin-Angiotensin-Aldosterone System, Blood Pressure, and Glycemia in African Americans. J Clin Endocrinol Metab 2020; 105:5841631. [PMID: 32436940 PMCID: PMC7308077 DOI: 10.1210/clinem/dgaa290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/18/2020] [Indexed: 12/31/2022]
Abstract
CONTEXT Armadillo repeat containing 5 (ARMC5) on chromosome 16 is an adrenal gland tumor suppressor gene associated with primary aldosteronism, especially among African Americans (AAs). We examined the association of ARMC5 variants with aldosterone, plasma renin activity (PRA), blood pressure, glucose, and glycosylated hemoglobin A1c (HbA1c) in community-dwelling AAs. METHODS The Jackson Heart Study is a prospective cardiovascular cohort study in AAs with baseline data collection from 2000 to 2004. Kernel machine method was used to perform a single joint test to analyze for an overall association between the phenotypes of interest (aldosterone, PRA, systolic and diastolic blood pressure [SBP, DBP], glucose, and HbA1c) and the ARMC5 single nucleotide variants (SNVs) adjusted for age, sex, BMI, and medications; followed by Baysian Lasso methodology to identify sets of SNVs in terms of associated haplotypes with specific phenotypes. RESULTS Among 3223 participants (62% female; mean age 55.6 (SD ± 12.8) years), the average SBP and DBP were 127 and 76 mmHg, respectively. The average fasting plasma glucose and HbA1c were 101 mg/dL and 6.0%, respectively. ARMC5 variants were associated with all 6 phenotypes. Haplotype TCGCC (ch16:31476015-31476093) was negatively associated, whereas haplotype CCCCTTGCG (ch16:31477195-31477460) was positively associated with SBP, DBP, and glucose. Haplotypes GGACG (ch16:31477790-31478013) and ACGCG (ch16:31477834-31478113) were negatively associated with aldosterone and positively associated with HbA1c and glucose, respectively. Haplotype GCGCGAGC (ch16:31471193-ch16:31473597(rs114871627) was positively associated with PRA and negatively associated with HbA1c. CONCLUSIONS ARMC5 variants are associated with aldosterone, PRA, blood pressure, fasting glucose, and HbA1c in community-dwelling AAs, suggesting that germline mutations in ARMC5 may underlie cardiometabolic disease in AAs.
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Affiliation(s)
- Joshua J Joseph
- The Ohio State University, Columbus, Ohio
- Correspondence and Reprint Requests: Joshua J. Joseph, MD, Department of Medicine, The Ohio State University Wexner Medical Center, 566 McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210; Phone: 614-346-8878; Fax: 614-366-0345;
| | | | - Mihail Zilbermint
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, Maryland
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Fabio R Faucz
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Maya B Lodish
- Division of Pediatric Endocrinology and Diabetes, University of California, San Francisco, San Francisco, California
| | - Annabel Berthon
- Institut Cochin, Centre National de la Recherche Scientifique (CNRS), INSERM, Université Paris Descartes, Paris, France
| | - James G Wilson
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Sherita H Golden
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shili Lin
- The Ohio State University, Columbus, Ohio
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The Effects of Salt and Glucose Intake on Angiotensin II and Aldosterone in Obese and Nonobese Patients with Essential Hypertension. Int J Hypertens 2020; 2020:6017105. [PMID: 32257423 PMCID: PMC7106922 DOI: 10.1155/2020/6017105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/01/2020] [Accepted: 02/12/2020] [Indexed: 12/21/2022] Open
Abstract
Background The exact mechanisms for the development of essential hypertension are not known. Activation of the renin-angiotensin-aldosterone system (RAAS) in adipose tissue may represent an important link between obesity and hypertension. This study investigates the effects of oral intake of glucose with and without NaCl on angiotensin II (AngII) and aldosterone in obese and nonobese patients with essential hypertension. Methods Twenty newly diagnosed untreated essential hypertensive patients and 15 normotensive control subjects matched for age, gender, and BMI were studied. Participants fasted overnight (8–10 hrs), and then each subject took 75 gm glucose alone and with 3 gm NaCl, each dissolved in 250 ml. Subjects were monitored for 2 hours. Half hourly BP, plasma glucose (PG), serum Na+, K+, insulin, AngII, and aldosterone were measured. Subjects were classified into obese (BMI >30 Kg/m2) (11 patients and 8 control) and nonobese (BMI <30 Kg/m2) (9 patients and 7 control). Results After intake of glucose with NaCl serum, AngII was significantly higher in obese hypertensive patients compared with nonobese patients (P = 0.016). Intake of glucose with NaCl resulted in a significantly higher serum Na in obese hypertensive patients compared with nonobese patients Na (P = 0.009). Serum aldosterone was significantly higher in obese patients (P = 0.03, after glucose; P = 0.003, after glucose with NaCl) and in nonobese patients (P = 0.000 and P = 0.000, respectively) compared with their respective normotensive control subjects. In obese and nonobese patients, intake of glucose and glucose with NaCl showed no significant change in the levels of serum AngII and aldosterone which was associated a significant increase in serum Na in obese patients (P = 0.03) and a highly significant reduction in serum K in nonobese patients (P = 0.001). Conclusion Failure of suppression or inappropriate maintenance of secretion of AngII and aldosterone in both hypertensive groups by intake of glucose with NaCl may indicate a possible mechanism of essential hypertension.
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Gershuni VM, Ermer JP, Kelz RR, Roses RE, Cohen DL, Trerotola SO, Fraker DL, Wachtel H. Clinical presentation and surgical outcomes in primary aldosteronism differ by race. J Surg Oncol 2020; 121:456-464. [PMID: 31858609 DOI: 10.1002/jso.25806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/02/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Primary aldosteronism (PA) is the most common cause of secondary hypertension; early diagnosis and intervention correlate with outcomes. We hypothesized that race may influence clinical presentation and outcomes. METHODS We conducted a retrospective analysis of patients with PA (1997-2017) who underwent adrenal vein sampling (AVS). Patients were classified by self-reported race as black or non-black. Improvement was defined as postoperative decrease in mean arterial pressure (MAP), antihypertensive medications (AHM), or both. RESULTS Among patients undergoing AVS (n = 443), 287 underwent adrenalectomy. Black patients (28.2%) had higher body mass index (33.9 vs 31.8 kg/m2 ; P = .01), longer median duration of hypertension (12 vs 10 years; P = .003), higher modified Elixhauser comorbidity index (2 vs 1; P = .004), and lower median income ($47 134 vs $78 280; P < .001). Black patients had similar aldosterone:renin ratios (150 vs 135.6 [ng/dL]/[ng·mL·-1 hr-1 ]; P = .23) compared to non-blacks. At long-term follow-up, black patients had a similar requirement for AHM (1 vs 0; P = .13) but higher MAP (100.6 vs 95.3 mm Hg; P = .004). CONCLUSION Black patients present with longer duration of hypertension and more comorbidities. They are equally likely to lateralize on AVS, suggesting similar disease phenotype. However, black patients demonstrate less improvement with adrenalectomy; this may reflect a delay in diagnosis or concomitant essential hypertension.
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Affiliation(s)
- Victoria M Gershuni
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jae P Ermer
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert E Roses
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debbie L Cohen
- Division of Renal, Electrolyte and Hypertension, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott O Trerotola
- Division of Vascular and Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas L Fraker
- Division of Vascular and Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Wachtel
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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9
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Rakugi H, Ito S, Itoh H, Okuda Y, Yamakawa S. Long-term phase 3 study of esaxerenone as mono or combination therapy with other antihypertensive drugs in patients with essential hypertension. Hypertens Res 2019; 42:1932-1941. [PMID: 31554937 PMCID: PMC8076031 DOI: 10.1038/s41440-019-0314-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 01/30/2023]
Abstract
This study investigated the long-term antihypertensive effects of esaxerenone, a novel nonsteroidal mineralocorticoid receptor blocker, alone or in combination with a calcium channel blocker (CCB) or a renin-angiotensin system (RAS) inhibitor, in Japanese patients with essential hypertension. Patients were treated with esaxerenone starting at 2.5 mg/day increasing to 5 mg/day if required to achieve blood pressure (BP) targets as a monotherapy or with a CCB or RAS inhibitor. After the first 12 weeks of treatment, an additional antihypertensive agent could be added if required to achieve the target BP; the total treatment period was 28 or 52 weeks. The primary endpoint was a change from baseline in sitting BP. Of the 368 enrolled patients, 245 received monotherapy, and 59 and 64, respectively, took a CCB or RAS inhibitor concurrently. Mean changes from baseline in sitting systolic/diastolic BP (95% confidence intervals) at weeks 12, 28 and 52 were -16.1 (-17.3, -14.9)/-7.7 (-8.4, -6.9), -18.9 (-20.2, -17.7)/-9.9 (-10.7, -9.2), and -23.1 (-25.0, -21.1)/-12.5 (-13.6, -11.3) mmHg, respectively (all P < 0.0001 vs baseline). Similar BP reductions at these weeks were observed between all patient subgroups stratified by age, and the observed decreases in 24-h ambulatory BP were consistent with the efficacy observed in sitting BP. Esaxerenone was also well-tolerated with a rate of hyperkalemia at 5.4% (serum potassium ≥5.5 mEq/L), indicating a good safety profile for treatment over the long-term or in combination with a CCB or RAS inhibitor. In conclusion, esaxerenone may be a promising treatment option for patients with hypertension.
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Affiliation(s)
- Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba, Sendai, Miyagi, 980-8575, Japan
| | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Yasuyuki Okuda
- Daiichi Sankyo Co., Ltd., 1-2-58 Hiromachi, Shinagawa, Tokyo, 140-8710, Japan
| | - Satoru Yamakawa
- Daiichi Sankyo Co., Ltd., 1-2-58 Hiromachi, Shinagawa, Tokyo, 140-8710, Japan
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Loss of secretin results in systemic and pulmonary hypertension with cardiopulmonary pathologies in mice. Sci Rep 2019; 9:14211. [PMID: 31578376 PMCID: PMC6775067 DOI: 10.1038/s41598-019-50634-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/23/2019] [Indexed: 12/16/2022] Open
Abstract
More than 1 billion people globally are suffering from hypertension, which is a long-term incurable medical condition that can further lead to dangerous complications and death if left untreated. In earlier studies, the brain-gut peptide secretin (SCT) was found to be able to control blood pressure by its cardiovascular and pulmonary effects. For example, serum SCT in patients with congestive heart failure was one-third of the normal level. These observations strongly suggest that SCT has a causal role in blood pressure control, and in this report, we used constitutive SCT knockout (SCT−/−) mice and control C57BL/6N mice to investigate differences in the morphology, function, underlying mechanisms and response to SCT treatment. We found that SCT−/− mice suffer from systemic and pulmonary hypertension with increased fibrosis in the lungs and heart. Small airway remodelling and pulmonary inflammation were also found in SCT−/− mice. Serum NO and VEGF levels were reduced and plasma aldosterone levels were increased in SCT−/− mice. Elevated cardiac aldosterone and decreased VEGF in the lungs were observed in the SCT−/− mice. More interestingly, SCT replacement in SCT−/− mice could prevent the development of heart and lung pathologies compared to the untreated group. Taken together, we comprehensively demonstrated the critical role of SCT in the cardiovascular and pulmonary systems and provide new insight into the potential role of SCT in the pathological development of cardiopulmonary and cardiovascular diseases.
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O'Shea PM, Griffin TP, Denieffe S, Fitzgibbon MC. The aldosterone to renin ratio in the diagnosis of primary aldosteronism: Promises and challenges. Int J Clin Pract 2019; 73:e13353. [PMID: 31009143 DOI: 10.1111/ijcp.13353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/16/2019] [Accepted: 04/18/2019] [Indexed: 12/20/2022] Open
Abstract
The complexity of evaluating patients for secondary treatable causes of hypertension is underappreciated. Primary aldosteronism (PA) is the most prevalent cause of secondary hypertension (3%-32% of hypertensive patients). The recent endocrine society clinical practice guideline (ESCPG), "The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment", differs from the previous version in the explicit recognition of PA as a major public health issue. Despite this, PA is underdiagnosed. The guidelines call on physicians to substantially ramp up the screening of hypertensive patients at risk of PA. Further, it recommends the plasma aldosterone to renin ratio (ARR), as the test of choice for screening for PA. However, the ARR is a highly variable test with reported diagnostic sensitivities and specificities ranging from 66% to 100% and 61% to 100%, respectively. Variability of the ARR can be attributed to the high degree of within-subject variation, differences in sampling protocols, laboratory assays, reporting units, the effect of medications and the population characteristics used to establish the decision thresholds. These factors render the possibility of false positive and false negative results-which have the potential to adversely impact patients. The limitations and caveats to the use of the ARR necessitate an effective clinic-laboratory interface, with specialist physician and clinical scientist collaboration for ARR result interpretation. Improvement in the diagnostic sensitivity and specificity of the ARR is predicated on harmonisation of pretesting patient preparation criteria, knowledge of the analytical methods used to derive the ratio and the method-specific threshold for PA.
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Affiliation(s)
- Paula M O'Shea
- Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland
| | - Tomás P Griffin
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Stephanie Denieffe
- University College Dublin and Department of Clinical Biochemistry & Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maria C Fitzgibbon
- Department of Clinical Biochemistry & Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
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The Association of Life's Simple 7 with Aldosterone among African Americans in the Jackson Heart Study. Nutrients 2019; 11:nu11050955. [PMID: 31035479 PMCID: PMC6566676 DOI: 10.3390/nu11050955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 01/21/2023] Open
Abstract
Background: Among African Americans (AAs), attaining higher levels of American Heart Association (AHA) ideal cardiovascular health (Life’s Simple 7 [LS7]) is associated with lower risk of diabetes and cardiovascular disease (CVD). We previously showed that aldosterone is associated with higher risk of diabetes and CVD in AAs. Thus, we investigated the association of LS7 metrics with aldosterone in the Jackson Heart Study (JHS). Methods: Ideal metrics were defined by AHA 2020 goals for health behaviors (smoking, dietary intake, physical activity, and body mass index) and health factors (total cholesterol, blood pressure, and fasting glucose). The number of ideal LS7 metrics attained at baseline were summed into a continuous score (0–7) and categorical groups (Poor: 0–1, Intermediate: 2–3, and Ideal: ≥4 ideal LS7 metrics). Multivariable linear regression was used. Results: Among 4,095 JHS participants (mean age 55 ± 13 years, 65% female), median serum aldosterone was 4.90, 4.30, and 3.70 ng/dL in the poor (n = 1132), intermediate (n = 2288) and ideal (n = 675) categories respectively. Aldosterone was 15% [0.85 (0.80, 0.90)] and 33% [0.67 (0.61, 0.75)] lower in the intermediate and ideal LS7 categories compared to the poor LS7 category. Each additional LS7 metric attained on continuous LS7 score (0–7) was associated with an 11% [0.89 (0.86, 0.91)] lower aldosterone level with variation by sex with women having a 15% lower aldosterone vs. 5% in men. Conclusions: Higher attainment of ideal LS7 metrics was associated with lower serum aldosterone among AAs with a greater magnitude of association among women compared to men.
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The regulation of aldosterone secretion by leptin: implications in obesity-related cardiovascular disease. Curr Opin Nephrol Hypertens 2018; 27:63-69. [PMID: 29135585 DOI: 10.1097/mnh.0000000000000384] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Although it has been known for some time that increases in body mass enhance aldosterone secretion, particularly in women, the origin of this elevation in aldosterone production is not well defined. Adipocyte-derived factors have emerged as potential candidates to increase aldosterone production in obesity. RECENT FINDINGS Emerging evidence suggests the presence of a mechanistic link in which the adipocyte-derived hormone leptin stimulates aldosterone production in obesity, thereby creating a positive feedback loop for obesity-associated cardiovascular disease. In addition, recent reports give credence to the concept that this leptin-aldosterone stimulation pathway in obesity is an underlying mechanism for sex-discrepancies in obesity-associated cardiovascular disease. SUMMARY Leptin appears as a new direct regulator of adrenal aldosterone production and leptin-mediated aldosterone production is a novel candidate mechanism underlying obesity-associated hypertension, particularly in females.
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Choo EH, Ha KH, Lee SW, Kim HC, Park S, Lee HY, Ihm SH. Low plasma renin activity is an independent predictor of near-term incidence of hypertension in Asian populations. Clin Exp Hypertens 2018; 41:330-335. [PMID: 29902069 DOI: 10.1080/10641963.2018.1481422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Plasma renin activity is involved in the regulation of body salt content and blood pressure. However, there is a paucity of data regarding the association between low or high plasma renin activity and the development of hypertension. METHOD We investigated the relation of baseline plasma renin activity to increases in blood pressure and the incidence of hypertension after four years in 2,146 non-hypertensive individuals from a community-based Korean population (mean age, 50 years), 58% of whom were women. We defined an "increase in blood pressure" as an increment of systolic blood-pressure ≥ 10 mmHg or initiation of antihypertensive drugs and defined "hypertension" as a systolic blood pressure of 140 mm Hg or higher, a diastolic blood pressure of 90 mm Hg or higher, or the use of antihypertensive medications. RESULTS After 4 years, the increase in blood pressure had increased in 27.9% of the participants, and hypertension had developed in 17.9%. After adjustment, the lowest sex-specific tertile of plasma renin activity was an independent risk factor of an elevation in blood pressure (Adjusted Odds Ratio 1.37, 95% confidence interval 1.07-1.74, p = 0.011) and hypertension (Adjusted Odds Ratio 1.84, 95% confidence interval 1.36-2.50, p < 0.001) compared to the highest sex-specific tertile. The associations between the plasma renin activity and blood-pressure outcomes were evident in adults with especially high urine sodium excretion. CONCLUSION Low plasma renin activity was associated with the development of hypertension in the middle-aged Asian population, especially in peoples with high sodium intake.
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Affiliation(s)
- Eun Ho Choo
- a Division of Cardiology , The Catholic University of Korea, College of Medicine , Seoul , Korea
| | - Kyoung Hwa Ha
- b Department of Public Health , Graduate School of Yonsei University , Seoul , Korea
| | - Seung-Won Lee
- b Department of Public Health , Graduate School of Yonsei University , Seoul , Korea
| | - Hyeon Chang Kim
- c Department of Preventive Medicine , Yonsei University College of Medicine , Seoul , Korea
| | - Sungha Park
- d Division of Cardiology , Yonsei Cardiovascular Hospital , Seoul , Korea
| | - Hae Young Lee
- e Department of Internal Medicine , Seoul National University Hospital , Seoul , Korea
| | - Sang-Hyun Ihm
- a Division of Cardiology , The Catholic University of Korea, College of Medicine , Seoul , Korea
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Tan JW, Gupta T, Manosroi W, Yao TM, Hopkins PN, Williams JS, Adler GK, Romero JR, Williams GH. Dysregulated aldosterone secretion in persons of African descent with endothelin-1 gene variants. JCI Insight 2017; 2:95992. [PMID: 29212952 DOI: 10.1172/jci.insight.95992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/02/2017] [Indexed: 01/05/2023] Open
Abstract
Compared with persons of European descent (ED), persons of African descent (AD) have lower aldosterone (ALDO) levels, with the assumption being that the increased cardiovascular disease (CVD) risk associated with AD is not related to ALDO. However, the appropriateness of the ALDO levels for the volume status in AD is unclear. We hypothesized that, even though ALDO levels are lower in AD, they are inappropriately increased, and therefore, ALDO could mediate the increased CVD in AD. To test this hypothesis, we analyzed data from HyperPATH - 1,788 individuals from the total cohort and 765 restricted to ED-to-AD in a 2:1 match and genotyped for the endothelin-1 gene (EDN1). Linear regression analyses with adjustments were performed. In the total and restricted cohorts, PRA, ALDO, and urinary potassium levels were significantly lower in AD. However, in the AD group, greater ALDO dysregulation was present as evidenced by higher ALDO/plasma renin activity (PRA) ratios (ARR) and sodium-modulated ALDO suppression-to-stimulation indices. Furthermore, EDN1 minor allele carriers had significantly greater ARRs than noncarriers but only in the AD group. ARR levels were modulated by a significant interaction between EDN1 and AD. Thus, EDN1 variants may identify particularly susceptible ADs who will be responsive to treatment targeting ALDO-dependent pathways (e.g., mineralocorticoid-receptor antagonists).
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Affiliation(s)
- Jia W Tan
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Cell & Molecular Biology Laboratory, Department of Cellular Biology & Pharmacology, Faculty of Medicine & Health Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Tina Gupta
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Worapaka Manosroi
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Endocrinology, Bangkok Hospital Chiang Mai, Chiang Mai, Thailand
| | - Tham M Yao
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul N Hopkins
- Cardiovascular Genetics Unit, Cardiology Division, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gail K Adler
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose R Romero
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gordon H Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Tancredi M, Johannsson G, Eliasson B, Eggertsen R, Lindblad U, Dahlqvist S, Imberg H, Lind M. Prevalence of primary aldosteronism among patients with type 2 diabetes. Clin Endocrinol (Oxf) 2017; 87:233-241. [PMID: 28493291 DOI: 10.1111/cen.13370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 11/27/2022]
Abstract
CONTEXT Diabetes and hypertension coexist in 40%-60% of individuals with type 2 diabetes. The coexistence of these two conditions is associated with increased risk of retinopathy, nephropathy and cardiovascular disease. OBJECTIVE To investigate the prevalence of primary aldosteronism (PA) in a general cohort of persons with type 2 diabetes. DESIGN Cross-sectional study involving six diabetes outpatient clinics in Sweden. PATIENTS were enrolled individuals with type 2 diabetes between February 2008 and December 2013. MEASUREMENTS Plasma aldosterone concentrations (PAC pmol/L) and direct renin concentrations (DRC mIU/L) were measured. Patients with increased aldosterone renin ratios (ARR) >65 were further evaluated for PA. RESULTS Of 578 consecutively screened patients with type 2 diabetes, 27 were treated with mineralocorticoid receptor antagonists (MRA) and potassium-sparing diuretics not further evaluated. Among the remaining 551 patients, 38 had increased ARR, including 22 who were clinically indicated for PA tests and 16 who were not further evaluated due to severe comorbidities and old age. There were five (0.93%) patients with confirmed PA after computerized tomography and adrenal venous sampling. Patients with PA had higher systolic blood pressure (P=.032) and lower potassium levels (P=.027) than those without PA. No significant association was found between plasma aldosterone and diabetic complications. CONCLUSIONS The prevalence of PA in an unselected cohort of patients with type 2 diabetes is relatively low, and measures of plasma aldosterone are not strong risk factors for micro- and macrovascular diabetic complications.
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Affiliation(s)
- Mauro Tancredi
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, NU-Hospital Group, Trollhättan and Uddevalla, Sweden
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition Institute of Medicine Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Robert Eggertsen
- Department of Public Health and Community Medicine, Institute of Medicine, Primary Health Care, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Lindblad
- Department of Public Health and Community Medicine, Institute of Medicine, Primary Health Care, University of Gothenburg, Gothenburg, Sweden
| | - Sofia Dahlqvist
- Department of Medicine, NU-Hospital Group, Trollhättan and Uddevalla, Sweden
| | - Henrik Imberg
- Statistiska Konsultgruppen, Gothenburg, Sweden
- Department of Mathematical Sciences, Chalmers University of Technology and the University of Gothenburg, Gothenburg, Sweden
| | - Marcus Lind
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, NU-Hospital Group, Trollhättan and Uddevalla, Sweden
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Joseph JJ, Echouffo-Tcheugui JB, Kalyani RR, Yeh HC, Bertoni AG, Effoe VS, Casanova R, Sims M, Wu WC, Wand GS, Correa A, Golden SH. Aldosterone, Renin, Cardiovascular Events, and All-Cause Mortality Among African Americans: The Jackson Heart Study. JACC-HEART FAILURE 2017; 5:642-651. [PMID: 28822744 DOI: 10.1016/j.jchf.2017.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/18/2017] [Accepted: 05/24/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This study examined the association of aldosterone and plasma renin activity (PRA) with incident cardiovascular disease (CVD), using a composite endpoint of coronary heart disease, stroke, and/or heart failure and mortality among African Americans in the Jackson Heart Study. BACKGROUND There is a paucity of data for the association of aldosterone and PRA with incident CVD or all-cause mortality among community-dwelling African Americans. METHODS A total of 4,985 African American adults, 21 to 94 years of age, were followed for 12 years. Aldosterone, PRA, and cardiovascular risk factors were collected at baseline (from 2000 to 2004). Incident events included coronary heart disease and stroke (assessed from 2000 to 2011) and heart failure (assessed from 2005 to 2011). Cox models were used to estimate hazard ratios (HRs) for incident CVD and mortality, adjusting for age, sex, education, occupation, current smoking, physical activity, dietary intake, and body mass index. RESULTS Among 4,160 participants without prevalent CVD over a median follow-up of 7 years, there were 322 incident CVD cases. In adjusted analyses, each 1-U SD increase in log-aldosterone and log-PRA were associated with HR of 1.26 (95% confidence intervals [CI]: 1.14 to 1.40) and 1.16 (95% CI: 1.02 to 1.33) for incident CVD, respectively. Over a median of 8 years, 513 deaths occurred among 4,985 participants. In adjusted analyses, each 1-U SD increase in log-aldosterone and log-PRA were associated with HRs of 1.13 (95% CI: 1.04 to 1.23) and 1.12 (95% CI: 1.01 to 1.24) for mortality, respectively. CONCLUSIONS Elevated aldosterone and PRA may play a significant role in the development of CVD and all-cause mortality among African Americans.
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Affiliation(s)
- Joshua J Joseph
- Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Bostons, Massachusetts
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hsin-Chieh Yeh
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alain G Bertoni
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Valery S Effoe
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ramon Casanova
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Wen-Chih Wu
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Gary S Wand
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sherita H Golden
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Nanba K, Vaidya A, Williams GH, Zheng I, Else T, Rainey WE. Age-Related Autonomous Aldosteronism. Circulation 2017; 136:347-355. [PMID: 28566337 DOI: 10.1161/circulationaha.117.028201] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/15/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Both aging and inappropriate secretion of aldosterone increase the risk for developing cardiovascular disease; however, the influence of aging on aldosterone secretion and physiology is not well understood. METHODS The relationship between age and adrenal aldosterone synthase (CYP11B2) expression was evaluated in 127 normal adrenal glands from deceased kidney donors (age, 9 months to 68 years). Following immunohistochemistry, CYP11B2-expressing area and areas of abnormal foci of CYP11B2-expressing cells, called aldosterone-producing cell clusters, were analyzed. In a separate ancillary clinical study of 677 participants without primary aldosteronism, who were studied on both high and restricted sodium diets (age, 18-71 years), we used multivariable linear regression to assess the independent associations between age and renin-angiotensin-aldosterone system physiology. RESULTS In adrenal tissue, the total CYP11B2-expressing area was negatively correlated with age (r=-0.431, P<0.0001), whereas the total aldosterone-producing cell cluster area was positively correlated with age (r=0.390, P<0.0001). The integrated ratio of aldosterone-producing cell cluster to CYP11B2-expressing area was most strongly and positively correlated with age (r=0.587, P<0.0001). When participants in the clinical study were maintained on a high sodium balance, renin activity progressively declined with older age, whereas serum and urinary aldosterone did not significantly decline. Correspondingly, the aldosterone-to-renin ratio was positively and independently associated with older age (adjusted β=+5.54 ng/dL per ng/mL per hour per 10 years, P<0.001). In contrast, when participants were assessed under sodium-restricted conditions, physiological stimulation of aldosterone was blunted with older age (β=-4.6 ng/dL per 10 years, P<0.0001). CONCLUSIONS Aging is associated with a pattern of decreased normal zona glomerulosa CYP11B2 expression and increased aldosterone-producing cell cluster expression. This histopathologic finding parallels an age-related autonomous aldosteronism and abnormal aldosterone physiology that provides 1 potential explanation for age-related cardiovascular risk.
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Affiliation(s)
- Kazutaka Nanba
- From Departments of Molecular and Integrative Physiology & Internal Medicine, University of Michigan, Ann Arbor (K.N., I.Z., W.E.R.); Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V., G.H.W.); and Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor (T.E., W.E.R.)
| | - Anand Vaidya
- From Departments of Molecular and Integrative Physiology & Internal Medicine, University of Michigan, Ann Arbor (K.N., I.Z., W.E.R.); Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V., G.H.W.); and Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor (T.E., W.E.R.)
| | - Gordon H Williams
- From Departments of Molecular and Integrative Physiology & Internal Medicine, University of Michigan, Ann Arbor (K.N., I.Z., W.E.R.); Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V., G.H.W.); and Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor (T.E., W.E.R.)
| | - Isabel Zheng
- From Departments of Molecular and Integrative Physiology & Internal Medicine, University of Michigan, Ann Arbor (K.N., I.Z., W.E.R.); Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V., G.H.W.); and Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor (T.E., W.E.R.)
| | - Tobias Else
- From Departments of Molecular and Integrative Physiology & Internal Medicine, University of Michigan, Ann Arbor (K.N., I.Z., W.E.R.); Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V., G.H.W.); and Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor (T.E., W.E.R.)
| | - William E Rainey
- From Departments of Molecular and Integrative Physiology & Internal Medicine, University of Michigan, Ann Arbor (K.N., I.Z., W.E.R.); Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V., G.H.W.); and Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor (T.E., W.E.R.).
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21
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Dinh Cat AN, Friederich-Persson M, White A, Touyz RM. Adipocytes, aldosterone and obesity-related hypertension. J Mol Endocrinol 2016; 57:F7-F21. [PMID: 27357931 DOI: 10.1530/jme-16-0025] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 12/15/2022]
Abstract
Understanding the mechanisms linking obesity with hypertension is important in the current obesity epidemic as it may improve therapeutic interventions. Plasma aldosterone levels are positively correlated with body mass index and weight loss in obese patients is reported to be accompanied by decreased aldosterone levels. This suggests a relationship between adipose tissue and the production/secretion of aldosterone. Aldosterone is synthesized principally by the adrenal glands, but its production may be regulated by many factors, including factors secreted by adipocytes. In addition, studies have reported local synthesis of aldosterone in extra-adrenal tissues, including adipose tissue. Experimental studies have highlighted a role for adipocyte-secreted aldosterone in the pathogenesis of obesity-related cardiovascular complications via the mineralocorticoid receptor. This review focuses on how aldosterone secretion may be influenced by adipose tissue and the importance of these mechanisms in the context of obesity-related hypertension.
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Affiliation(s)
- Aurelie Nguyen Dinh Cat
- Institute of Cardiovascular and Medical SciencesBHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Malou Friederich-Persson
- Institute of Cardiovascular and Medical SciencesBHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Anna White
- Institute of Cardiovascular and Medical SciencesBHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical SciencesBHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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Huby AC, Antonova G, Groenendyk J, Gomez-Sanchez CE, Bollag WB, Filosa JA, Belin de Chantemèle EJ. Adipocyte-Derived Hormone Leptin Is a Direct Regulator of Aldosterone Secretion, Which Promotes Endothelial Dysfunction and Cardiac Fibrosis. Circulation 2015; 132:2134-45. [PMID: 26362633 DOI: 10.1161/circulationaha.115.018226] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 09/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In obesity, the excessive synthesis of aldosterone contributes to the development and progression of metabolic and cardiovascular dysfunctions. Obesity-induced hyperaldosteronism is independent of the known regulators of aldosterone secretion, but reliant on unidentified adipocyte-derived factors. We hypothesized that the adipokine leptin is a direct regulator of aldosterone synthase (CYP11B2) expression and aldosterone release and promotes cardiovascular dysfunction via aldosterone-dependent mechanisms. METHODS AND RESULTS Immunostaining of human adrenal cross-sections and adrenocortical cells revealed that adrenocortical cells coexpress CYP11B2 and leptin receptors. Measurements of adrenal CYP11B2 expression and plasma aldosterone levels showed that increases in endogenous (obesity) or exogenous (infusion) leptin dose-dependently raised CYP11B2 expression and aldosterone without elevating plasma angiotensin II, potassium or corticosterone. Neither angiotensin II receptors blockade nor α and β adrenergic receptors inhibition blunted leptin-induced aldosterone secretion. Identical results were obtained in cultured adrenocortical cells. Enhanced leptin signaling elevated CYP11B2 expression and plasma aldosterone, whereas deficiency in leptin or leptin receptors blunted obesity-induced increases in CYP11B2 and aldosterone, ruling out a role for obesity per se. Leptin increased intracellular calcium, elevated calmodulin and calmodulin-kinase II expression, whereas calcium chelation blunted leptin-mediated increases in CYP11B2, in adrenocortical cells. Mineralocorticoid receptor blockade blunted leptin-induced endothelial dysfunction and increases in cardiac fibrotic markers. CONCLUSIONS Leptin is a newly described regulator of aldosterone synthesis that acts directly on adrenal glomerulosa cells to increase CYP11B2 expression and enhance aldosterone production via calcium-dependent mechanisms. Furthermore, leptin-mediated aldosterone secretion contributes to cardiovascular disease by promoting endothelial dysfunction and the expression of profibrotic markers in the heart.
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Affiliation(s)
- Anne-Cécile Huby
- From Physiology Department, Medical College of Georgia at Georgia Regents University, Augusta (A.-C.H., G.A., J.G., W.B.B., J.A.F., E.J.D.d.C.); Charlie Norwood VA Medical Center, Augusta, GA (W.B.B.); Endocrine Section, G.V. (Sonny) Montgomery VA Medical Center, and University of Mississippi Medical Center, Jackson (C..E.G.-S.)
| | - Galina Antonova
- From Physiology Department, Medical College of Georgia at Georgia Regents University, Augusta (A.-C.H., G.A., J.G., W.B.B., J.A.F., E.J.D.d.C.); Charlie Norwood VA Medical Center, Augusta, GA (W.B.B.); Endocrine Section, G.V. (Sonny) Montgomery VA Medical Center, and University of Mississippi Medical Center, Jackson (C..E.G.-S.)
| | - Jake Groenendyk
- From Physiology Department, Medical College of Georgia at Georgia Regents University, Augusta (A.-C.H., G.A., J.G., W.B.B., J.A.F., E.J.D.d.C.); Charlie Norwood VA Medical Center, Augusta, GA (W.B.B.); Endocrine Section, G.V. (Sonny) Montgomery VA Medical Center, and University of Mississippi Medical Center, Jackson (C..E.G.-S.)
| | - Celso E Gomez-Sanchez
- From Physiology Department, Medical College of Georgia at Georgia Regents University, Augusta (A.-C.H., G.A., J.G., W.B.B., J.A.F., E.J.D.d.C.); Charlie Norwood VA Medical Center, Augusta, GA (W.B.B.); Endocrine Section, G.V. (Sonny) Montgomery VA Medical Center, and University of Mississippi Medical Center, Jackson (C..E.G.-S.)
| | - Wendy B Bollag
- From Physiology Department, Medical College of Georgia at Georgia Regents University, Augusta (A.-C.H., G.A., J.G., W.B.B., J.A.F., E.J.D.d.C.); Charlie Norwood VA Medical Center, Augusta, GA (W.B.B.); Endocrine Section, G.V. (Sonny) Montgomery VA Medical Center, and University of Mississippi Medical Center, Jackson (C..E.G.-S.)
| | - Jessica A Filosa
- From Physiology Department, Medical College of Georgia at Georgia Regents University, Augusta (A.-C.H., G.A., J.G., W.B.B., J.A.F., E.J.D.d.C.); Charlie Norwood VA Medical Center, Augusta, GA (W.B.B.); Endocrine Section, G.V. (Sonny) Montgomery VA Medical Center, and University of Mississippi Medical Center, Jackson (C..E.G.-S.)
| | - Eric J Belin de Chantemèle
- From Physiology Department, Medical College of Georgia at Georgia Regents University, Augusta (A.-C.H., G.A., J.G., W.B.B., J.A.F., E.J.D.d.C.); Charlie Norwood VA Medical Center, Augusta, GA (W.B.B.); Endocrine Section, G.V. (Sonny) Montgomery VA Medical Center, and University of Mississippi Medical Center, Jackson (C..E.G.-S.).
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Zilbermint M, Xekouki P, Faucz FR, Berthon A, Gkourogianni A, Schernthaner-Reiter MH, Batsis M, Sinaii N, Quezado MM, Merino M, Hodes A, Abraham SB, Libé R, Assié G, Espiard S, Drougat L, Ragazzon B, Davis A, Gebreab SY, Neff R, Kebebew E, Bertherat J, Lodish MB, Stratakis CA. Primary Aldosteronism and ARMC5 Variants. J Clin Endocrinol Metab 2015; 100:E900-9. [PMID: 25822102 PMCID: PMC4454793 DOI: 10.1210/jc.2014-4167] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Primary aldosteronism is one of the leading causes of secondary hypertension, causing significant morbidity and mortality. A number of genetic defects have recently been identified in primary aldosteronism, whereas we identified mutations in ARMC5, a tumor-suppressor gene, in cortisol-producing primary macronodular adrenal hyperplasia. OBJECTIVE We investigated a cohort of 56 patients who were referred to the National Institutes of Health for evaluation of primary aldosteronism for ARMC5 defects. METHODS Patients underwent step-wise diagnosis, with measurement of serum aldosterone and plasma renin activity followed by imaging, saline suppression and/or oral salt loading tests, plus adrenal venous sampling. Cortisol secretion was also evaluated; unilateral or bilateral adrenalectomy was performed, if indicated. DNA, protein, and transfection studies in H295R cells were conducted by standard methods. RESULTS We identified 12 germline ARMC5 genetic alterations in 20 unrelated and two related individuals in our cohort (39.3%). ARMC5 sequence changes in 6 patients (10.7%) were predicted to be damaging by in silico analysis. All affected patients carrying a variant predicted to be damaging were African Americans (P = .0023). CONCLUSIONS Germline ARMC5 variants may be associated with primary aldosteronism. Additional cohorts of patients with primary aldosteronism and metabolic syndrome, particularly African Americans, should be screened for ARMC5 sequence variants because these may underlie part of the known increased predisposition of African Americans to low renin hypertension.
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Mohandas A, Suboc TB, Wang J, Ying R, Tarima S, Dharmashankar K, Malik M, Widlansky ME. Mineralocorticoid exposure and receptor activity modulate microvascular endothelial function in African Americans with and without hypertension. Vasc Med 2015; 20:401-8. [PMID: 25978968 DOI: 10.1177/1358863x15584753] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prior work suggests blood pressure in African Americans is more sensitive to the effects of aldosterone than in Caucasians. This mechanism may relate to a negative response of the vascular endothelium to aldosterone, including reduced glucose-6-phosphate dehydrogenase (G6PD) activity. Thirty-three African Americans (11 hypertensives, 22 controls) without evidence of diabetes or metabolic syndrome completed the protocol. The protocol included measurement of in vivo microvascular endothelial function by digital pulse arterial tonometry and ex vivo measurement of endothelial function by videomicroscopy of arterioles obtained from these same subjects with and without exposure to aldosterone or spironolactone. Systemic and arteriolar G6PD activities were also measured. In vivo and ex vivo microvascular endothelial function were impaired in African Americans with hypertension. One-hour exposure with aldosterone impaired endothelium-dependent vasodilation in arterioles from normotensive subjects, while 1 hour of spironolactone exposure reversed endothelial dysfunction in arterioles from hypertensive subjects. G6PD activity was impaired in hypertensive arterioles. Aldosterone-related endothelial dysfunction may be responsible for at least a portion of the greater blood pressure sensitivity to aldosterone in African Americans. This may be in part related to vascular suppression of G6PD activity.
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Affiliation(s)
- Appesh Mohandas
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tisha B Suboc
- Department of Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jingli Wang
- Department of Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rong Ying
- Department of Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sergey Tarima
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kodlipet Dharmashankar
- Department of Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mobin Malik
- Department of Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael E Widlansky
- Department of Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Rifkin DE, Khaki AR, Jenny NS, McClelland RL, Budoff M, Watson K, Ix JH, Allison MA. Association of renin and aldosterone with ethnicity and blood pressure: the Multi-Ethnic Study of Atherosclerosis. Am J Hypertens 2014; 27:801-10. [PMID: 24436325 DOI: 10.1093/ajh/hpt276] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although variations in plasma renin activity (PRA) and aldosterone have been examined in whites and blacks, the association of these hormones with blood pressure in multiethnic populations has not been described. METHODS We measured PRA and aldosterone in 1,021 participants in the Multi-Ethnic Study of Atherosclerosis not taking antihypertensives and examined the association between ethnicity and PRA/aldosterone and the association between PRA/aldosterone with systolic blood pressure (SBP). RESULTS Average age was 62 (SD = 9) years, and 49% of participants were women. Median PRA was 0.51 (interquartile range (IQR) = 0.29-0.87) ng/ml/hour, and median aldosterone was 12.6 (IQR = 9.1-17.1) ng/dl. After age and sex adjustment, compared with whites, blacks had 28% lower PRA and 17.4% lower aldosterone, and Hispanics had 20.1% higher PRA but similar aldosterone levels. After multivariable adjustment, compared with whites, only Hispanic ethnicity independently associated with higher PRA (0.18ng/ml/hour; 95% confidence interval (CI) = 0.06-0.31). Blacks had lower aldosterone (-1.7ng/dl; 95% CI = -3.2 to -0.2) compared with whites. After multivariable adjustment, PRA was associated with lower SBP in whites (-3.2mm Hg; 95% CI = -5.2 to -1.2 per standardized unit PRA), Chinese (-3.5mm Hg; 95% CI = -6.2 to -0.80 per standardized unit), and Hispanics (-2.3mm Hg; 95% CI = -4.1 to -0.6 per standardized unit) but not blacks. Aldosterone was associated with higher SBP only in Hispanics (2.5mm Hg; 95% CI = 0.4-4.5 per SD). CONCLUSIONS Compared with whites, blacks have lower aldosterone and Hispanics have higher PRA. Aldosterone had significant associations with higher SBP in Hispanics compared with other groups, a finding that may suggest a different mechanism of hypertension.
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Affiliation(s)
- Dena E Rifkin
- Division of Nephrology, Department of Medicine, University of California-San Diego, San Diego, California
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Abstract
Hypertension is an established risk factor for stroke, premature coronary artery disease and heart failure. Control of elevated blood pressure has been shown to result in significant reduction of cardiovascular risk. Aldosterone, the final product of the renin-angiotensin-aldosterone system (RAAS), not only causes salt and water reabsorbtion in the kidneys through its effect on the mineralocorticoid hormone receptor (MR), but also an MR-independent effect, not regulated by conventional MR blockade. Although many pharmacological agents target different levels of the RAAS cascade, these generally result in elevated renin concentration and plasma renin activity. This upstream feedback response subsequently results in elevated levels of angiotensin II, a potent vasoconstrictor and stimulus to aldosterone release. This aldosterone breakthrough counteracts the long-term blood pressure-lowering effect of these agents. Therefore the development of a new class of pharmacologic agents that directly inhibit the production of aldosterone may prove clinically useful in reducing aldosterone and thereby controlling elevated blood pressure.
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Affiliation(s)
- Karl Andersen
- Cardiovascular Research Center, Landspitali the University Hospital of Iceland, IS-101, Reykjavik, Iceland,
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Deo R, Yang W, Khan AM, Bansal N, Zhang X, Leonard MB, Keane MG, Soliman EZ, Steigerwalt S, Townsend RR, Shlipak MG, Feldman HI. Serum aldosterone and death, end-stage renal disease, and cardiovascular events in blacks and whites: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. Hypertension 2014; 64:103-10. [PMID: 24752431 DOI: 10.1161/hypertensionaha.114.03311] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Prior studies have demonstrated that elevated aldosterone concentrations are an independent risk factor for death in patients with cardiovascular disease. Limited studies, however, have evaluated systematically the association between serum aldosterone and adverse events in the setting of chronic kidney disease. We investigated the association between serum aldosterone and death and end-stage renal disease in 3866 participants from the Chronic Renal Insufficiency Cohort. We also evaluated the association between aldosterone and incident congestive heart failure and atherosclerotic events in participants without baseline cardiovascular disease. Cox proportional hazards models were used to evaluate independent associations between elevated aldosterone concentrations and each outcome. Interactions were hypothesized and explored between aldosterone and sex, race, and the use of loop diuretics and renin-angiotensin-aldosterone system inhibitors. During a median follow-up period of 5.4 years, 587 participants died, 743 developed end-stage renal disease, 187 developed congestive heart failure, and 177 experienced an atherosclerotic event. Aldosterone concentrations (per SD of the log-transformed aldosterone) were not an independent risk factor for death (adjusted hazard ratio, 1.00; 95% confidence interval, 0.93-1.12), end-stage renal disease (adjusted hazard ratio, 1.07; 95% confidence interval, 0.99-1.17), or atherosclerotic events (adjusted hazard ratio, 1.04; 95% confidence interval, 0.85-1.18). Aldosterone was associated with congestive heart failure (adjusted hazard ratio, 1.21; 95% confidence interval, 1.02-1.35). Among participants with chronic kidney disease, higher aldosterone concentrations were independently associated with the development of congestive heart failure but not for death, end-stage renal disease, or atherosclerotic events. Further studies should evaluate whether mineralocorticoid receptor antagonists may reduce adverse events in individuals with chronic kidney disease because elevated cortisol levels may activate the mineralocorticoid receptor.
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Affiliation(s)
- Rajat Deo
- From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.).
| | - Wei Yang
- From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.)
| | - Abigail M Khan
- From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.)
| | - Nisha Bansal
- From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.)
| | - Xiaoming Zhang
- From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.)
| | - Mary B Leonard
- From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.)
| | - Martin G Keane
- From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.)
| | - Elsayed Z Soliman
- From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.)
| | - Susan Steigerwalt
- From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.)
| | - Raymond R Townsend
- From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.)
| | - Michael G Shlipak
- From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.)
| | - Harold I Feldman
- From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.)
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Tu W, Eckert GJ, Hannon TS, Liu H, Pratt LM, Wagner MA, Dimeglio LA, Jung J, Pratt JH. Racial differences in sensitivity of blood pressure to aldosterone. Hypertension 2014; 63:1212-8. [PMID: 24711519 DOI: 10.1161/hypertensionaha.113.02989] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Blacks in comparison with whites are at risk for a more serious form of hypertension with high rates of complications. Greater sodium retention is thought to underlie the blood pressure (BP)-determining physiology of blacks, but specific mechanisms have not been identified. In a prospective observational study of BP, 226 black children and 314 white children (mean age, 10.6 years) were enrolled initially. Assessments were repeated in 85 blacks and 136 whites after reaching adulthood (mean age, 31 years). The relationship of BP to plasma aldosterone concentration in the context of the prevailing level of plasma renin activity was studied in blacks and whites. In a secondary interventional study, 9-α fludrocortisone was administered for 2 weeks to healthy adult blacks and whites to simulate hyperaldosteronism. BP responses in the 2 race groups were then compared. Although black children had lower levels of plasma renin activity and plasma aldosterone, their BP was positively associated with the plasma aldosterone concentration, an effect that increased as plasma renin activity decreased (P=0.004). Data from black adults yielded similar results. No similar relationship was observed in whites. In the interventional study, 9-α fludrocortisone increased BP in blacks but not in whites. In conclusion, aldosterone sensitivity is a significant determinant of BP in young blacks. Although its role in establishing the risk of hypertension is not known, it could be as relevant as the actual level of aldosterone.
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Affiliation(s)
- Wanzhu Tu
- 541 Clinical Dr, CL 365a, Indianapolis, IN 46202-5111.
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Grübler MR, Kienreich K, Gaksch M, Verheyen N, Fahrleitner-Pammer A, Schmid J, Grogorenz J, Ablasser K, Pieske B, Tomaschitz A, Pilz S. Aldosterone to active renin ratio is associated with nocturnal blood pressure in obese and treated hypertensive patients: the Styrian Hypertension Study. J Clin Hypertens (Greenwich) 2014; 16:289-94. [PMID: 24666971 DOI: 10.1111/jch.12274] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/07/2013] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
Abstract
High aldosterone levels are considered to play a key role in arterial hypertension. Data on the relationship between the aldosterone to active renin ratio (AARR), a quantity of aldosterone excess, and ambulatory blood pressure (BP) monitoring (ABPM) during the night are, however, sparse. Hypertensive patients were recruited from local outpatient clinics who underwent 24-hour urine collection and in parallel ABPM. Plasma aldosterone and renin concentrations were measured by radioimmunoassay. A total of 211 patients (age, 60.2±10.2 years; 51.9% female) with a mean systolic/diastolic ABPM value of 128.7±12.8/77.1±9.2 mm Hg were evaluated. In backwards linear regression analyses adjusted for age, sex, body mass index, smoking, glomerular filtration rate, hemoglobin A1c , N-terminal prohormone of brain natriuretic peptide, urinary sodium/potassium ratio, and ongoing antihypertensive medication, AARR was significantly associated with nocturnal systolic (ß-coefficient: 0.177; P=.017) and diastolic BP (ß-coefficient: 0.162; P=.027). In patients with arterial hypertension, a significant association between AARR and nighttime BP even after adjustment for a broad panel of confounders was found.
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Affiliation(s)
- Martin R Grübler
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Cardiology, Medical University of Graz, Graz, Austria
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Satoh M, Hosaka M, Asayama K, Kikuya M, Inoue R, Metoki H, Utsugi MT, Hara A, Hirose T, Obara T, Mori T, Totsune K, Hoshi H, Mano N, Imai Y, Ohkubo T. Aldosterone-to-renin ratio and nocturnal blood pressure decline assessed by self-measurement of blood pressure at home: the Ohasama Study. Clin Exp Hypertens 2014; 36:108-14. [DOI: 10.3109/10641963.2014.892121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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31
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Shibata D, Tillin T, Beauchamp N, Heasman J, Hughes AD, Park C, Gedroyc W, Chaturvedi N. African Caribbeans have greater subclinical cerebrovascular disease than Europeans: this is associated with both their elevated resting and ambulatory blood pressure and their hyperglycaemia. J Hypertens 2013; 31:2391-9. [PMID: 24029870 PMCID: PMC4082237 DOI: 10.1097/hjh.0b013e328364f5bc] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Stroke is elevated in people of black African descent, but evidence for excess subclinical cerebrovascular disease is conflicting, and the role of risk factors in determining any ethnic differences observed unexplored. METHODS We compared prevalence of brain infarcts, and severe white matter hyperintensities (WMHs) on cerebral MRI, in a community-based sample of men and women aged 58-86 of African Caribbean (214) and European (605) descent, in London, UK. Resting, central and ambulatory blood pressure (BP) were measured; diabetes was assessed by blood testing and questionnaire. RESULTS Mean age was 70. Multiple (≥4) brain infarcts and severe WMH occurred more frequently in African Caribbeans (18/43%), than Europeans (7/33%, P=0.05/0.008). Separately, clinic and night-time ambulatory BP were significantly associated with severe WMH in both ethnic groups; when both were entered into the model, the association for clinic SBP was attenuated and lost statistical significance [1.00 (0.98-1.02) P=0.9 in Europeans, 1.00 (0.97-1.04) P=0.9 in African Caribbeans], whereas the association for night-time SBP was retained [1.04 (1.02-1.07) P<0.001 in Europeans, 1.08 (1.03-1.12), P=0.001 in African Caribbeans]. The greater age-adjusted and sex-adjusted risk of severe WMH in African Caribbeans compared with Europeans [2.08 (1.15-3.76) P=0.02], was attenuated to 1.45 [(0.74-2.83) P=0.3] on adjustment for clinic and night-time systolic pressure, antihypertensive medication use and glycated haemoglobin. CONCLUSION African Caribbeans have a greater burden of subclinical cerebrovascular disease than Europeans. This excess is related to elevated clinic and ambulatory BP, and to hyperglycaemia.
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Affiliation(s)
- Dean Shibata
- Department of Radiology, University of Washington Medical Centre, Seattle, Washington, USA
| | - Therese Tillin
- National Heart & Lung Institute, Imperial College London
| | - Norman Beauchamp
- Department of Radiology, University of Washington Medical Centre, Seattle, Washington, USA
| | - John Heasman
- Department of Radiology, St Mary’s Hospital, Imperial College NHS Healthcare Trust, London, UK
| | - Alun D. Hughes
- National Heart & Lung Institute, Imperial College London
| | - Chloe Park
- National Heart & Lung Institute, Imperial College London
| | - Wady Gedroyc
- Department of Radiology, St Mary’s Hospital, Imperial College NHS Healthcare Trust, London, UK
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Brewster LM, Seedat YK. Why do hypertensive patients of African ancestry respond better to calcium blockers and diuretics than to ACE inhibitors and β-adrenergic blockers? A systematic review. BMC Med 2013; 11:141. [PMID: 23721258 PMCID: PMC3681568 DOI: 10.1186/1741-7015-11-141] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 04/17/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Clinicians are encouraged to take an individualized approach when treating hypertension in patients of African ancestry, but little is known about why the individual patient may respond well to calcium blockers and diuretics, but generally has an attenuated response to drugs inhibiting the renin-angiotensin system and to β-adrenergic blockers. Therefore, we systematically reviewed the factors associated with the differential drug response of patients of African ancestry to antihypertensive drug therapy. METHODS Using the methodology of the systematic reviews narrative synthesis approach, we sought for published or unpublished studies that could explain the differential clinical efficacy of antihypertensive drugs in patients of African ancestry. PUBMED, EMBASE, LILACS, African Index Medicus and the Food and Drug Administration and European Medicines Agency databases were searched without language restriction from their inception through June 2012. RESULTS We retrieved 3,763 papers, and included 72 reports that mainly considered the 4 major classes of antihypertensive drugs, calcium blockers, diuretics, drugs that interfere with the renin-angiotensin system and β-adrenergic blockers. Pharmacokinetics, plasma renin and genetic polymorphisms did not well predict the response of patients of African ancestry to antihypertensive drugs. An emerging view that low nitric oxide and high creatine kinase may explain individual responses to antihypertensive drugs unites previous observations, but currently clinical data are very limited. CONCLUSION Available data are inconclusive regarding why patients of African ancestry display the typical response to antihypertensive drugs. In lieu of biochemical or pharmacogenomic parameters, self-defined African ancestry seems the best available predictor of individual responses to antihypertensive drugs.
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Affiliation(s)
- Lizzy M Brewster
- Departments of Internal and Vascular Medicine, F4-222, Academic Medical Center, Meibergdreef 9, Amsterdam, AZ, 1105, The Netherlands.
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Abstract
BACKGROUND Left ventricular hypertrophy (LVH) poses a great risk of cardiovascular morbidity and mortality in adults and may pose a serious risk in children. Adult studies have shown that renin-angiotensin-aldosterone system (RAAS) levels directly correlate with left ventricular mass index (LVMI). The purpose of this study is to explore race- and sex-related effects of the RAAS on LVMI in adolescents. METHODS Data were collected from a sample of 89 blacks (44 girls, 45 boys) and 102 whites (40 girls, 62 boys) aged 15-19. Data collected included sex, age, body mass index (BMI), LVMI, baseline blood pressure, and levels of aldosterone and angiotensin II. RESULTS In black males, increased aldosterone levels correlated with decreased sodium excretion (r= -0.336, p=0.024), increased blood pressure (r=0.358, p=0.016), and increased LVMI (r=0.342, p=0.022). In black females, increased aldosterone levels correlated with increased baseline blood pressure (r=0.356, p=0.018). In white males, increased aldosterone correlated with decreased sodium excretion (r= -0.391, p=0.002). In white females, aldosterone levels correlated with increased baseline blood pressure (r=0.323, p=0.042) and decreased sodium excretion (r= -0.342, p=0.031). CONCLUSIONS The results suggest the following model in black males: increased aldosterone leads to increased sodium retention, causing a volume-mediated increase in blood pressure; increased blood pressure results in increased left ventricular mass, and eventually LVH.
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Babayev R, Whaley-Connell A, Kshirsagar A, Klemmer P, Navaneethan S, Chen SC, Li S, McCullough PA, Bakris G, Bomback A. Association of race and body mass index with ESRD and mortality in CKD stages 3-4: results from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2012; 61:404-12. [PMID: 23260275 DOI: 10.1053/j.ajkd.2012.11.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 11/13/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND A recent cross-sectional analysis of Kidney Early Evaluation Program (KEEP) participants suggested that obesity is a heterogeneous disease state in African Americans and whites with chronic kidney disease (CKD). STUDY DESIGN In longitudinal analyses spanning 8 years of follow-up, we examined whether race and body mass index (BMI) influence end-stage renal disease (ESRD) and mortality rates in participants with CKD stages 3-4. SETTING & PARTICIPANTS KEEP participants were included in this analysis if they met the following criteria: (1) estimated glomerular filtration rate (eGFR) of 15-59 mL/min/1.73 m(2), (2) white or African American race, and (3) no previous dialysis or transplantation. OUTCOMES & MEASUREMENTS Survival analyses were performed for the outcomes of ESRD, death, and combined outcome of ESRD or death. RESULTS Of 14,631 participants with CKD stages 3-4, 28% were African American and 72% were white. African American participants had higher rates of obesity and hypertension, with a higher baseline mean eGFR, higher prevalence of albuminuria, and greater degree of anemia compared with whites. In multivariable models, African American race increased the risk of ESRD (HR, 1.66; 95% CI, 1.26-2.07), but not death (HR, 0.89; 95% CI, 0.76-1.03). In these models, male sex, hypertension, diabetes, lower baseline eGFR, and albuminuria were predictive of higher rates of ESRD; age, male sex, diabetes, lower baseline eGFR, and albuminuria were predictive of overall mortality. There was no significant interaction between race and BMI in the adjusted model for outcomes of ESRD (P = 0.7) or death (P = 0.3). LIMITATIONS Baseline values used in the analysis are from a cross-sectional data set. Dyslipidemia and secondary hyperparathyroidism were not accounted for in the analysis. CONCLUSIONS African American race was associated with a higher incidence of ESRD, but not mortality. Although obesity may be a heterogeneous disease state in African Americans and whites with CKD, there does not appear to be a significant interaction between race and BMI in progression to ESRD or death.
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Affiliation(s)
- Revekka Babayev
- Department of Medicine, Columbia University Medical Center, New York, NY, USA.
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Association of elevated plasma aldosterone-to-renin ratio with future cardiovascular events in patients with essential hypertension. J Hypertens 2012; 30:2322-30. [DOI: 10.1097/hjh.0b013e328359862d] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Sigurjonsdottir HA, Gronowitz M, Andersson O, Eggertsen R, Herlitz H, Sakinis A, Wangberg B, Johannsson G. Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study. BMC Endocr Disord 2012; 12:17. [PMID: 22958674 PMCID: PMC3515501 DOI: 10.1186/1472-6823-12-17] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 08/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The existence of unilateral adrenal hyperplasia (AH) has been considered a rare cause of primary hyperaldosteronism (PA). METHODS In a prospective study we screened for PA in a non-selected (NSP) and selected hypertensive population (SP), to define the cause of PA. We included 353 consecutive patients with hypertension; age 20 to 88 years, 165 women and 188 men, from a university-based Hypertension and Nephrology Outpatient clinics (123 SP) and two primary care centres, (230 NSP) from the same catch-up area. Serum aldosterone and plasma renin activity (PRA) were measured and the ARR calculated. Verifying diagnostic procedure was performed in patients with both elevated aldosterone and ARR. Patients diagnosed with PA were invited for adrenal venous sampling (AVS) and offered laparoscopic adrenalectomy when AVS found the disease to be unilateral. RESULTS After screening, 46 patients, 13% of the whole population (22.8% SP and 7.8% NSP) had aldosterone and ARR above the locally defined cut-off limits (0.43 nmol/l and 1.28 respectively). After diagnostic verification, 20 patients (6%) had PA, (14.5% SP and 1.4% NSP). Imaging diagnostic procedures with CT-scans and scintigraphy were inconclusive. AVS, performed in 15 patients verified bilateral disease in 4 and unilateral in 10 patients. One AVS failed. After laparoscopic adrenalectomy, 4 patients were found to have adenoma and 5 unilateral AH. One patient denied operation. CONCLUSION The prevalence of PA was in agreement with previous studies. The study finds unilateral PA common and unilateral AH as half of those cases. As may be suspected PA is found in much higher frequency in specialised hypertensive units compared to primary care centers. AVS was mandatory in diagnosis of unilateral PA.
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Affiliation(s)
- Helga Agusta Sigurjonsdottir
- Department of Medicine, Centrum of Endocrinology and Metabolism, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | | | - Ove Andersson
- Department of Medicine, Hypertension Outpatient Clinic, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Robert Eggertsen
- Department of Medicine Primary Health Care, Mölnlycke Primary Health Care and Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Hans Herlitz
- Department of Medicine, Nephrology Outpatient Clinic, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Augustinas Sakinis
- Dept of Radiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Bo Wangberg
- Dept of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Medicine, Centrum of Endocrinology and Metabolism, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
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37
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'Volume-expanded' hypertension: the effect of fluid overload and the role of the sympathetic nervous system in salt-dependent hypertension. J Hypertens 2012; 30:655-9. [PMID: 22227820 DOI: 10.1097/hjh.0b013e32834f6de1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It is widely believed that salt-dependent hypertension is induced and maintained by expansion of intravascular fluid volume resulting from excessive retention of sodium. The purpose of this brief article is to present a series of arguments in support of the thesis that volume overload per se does not raise the arterial blood pressure. Several investigators in the 1960s and 1970s reported that excessive retention of salt - regardless of cause - leads to sympathetic activation mediated by the effects of the Na ion on α(2)-adrenergic receptors located mostly in the brainstem. In recent years, the cloning and characterization of α(2)-adrenergic receptors subtypes permitted differentiation of their hemodynamic effects via use of salt loading of nephrectomized animals submitted to genetic engineering or gene treatment. These studies indicate that sodium alters the balance between the sympathoinhibitory α(2A)-adrenergic receptors and the sympathoexcitatory α(2B)-adrenergic receptors, leading to a hyperadrenergic hypertensive state unrelated to volume overload.
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38
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Hannemann A, Bidlingmaier M, Friedrich N, Manolopoulou J, Spyroglou A, Völzke H, Beuschlein F, Seissler J, Rettig R, Felix SB, Biffar R, Döring A, Meisinger C, Peters A, Wichmann HE, Nauck M, Wallaschofski H, Reincke M. Screening for primary aldosteronism in hypertensive subjects: results from two German epidemiological studies. Eur J Endocrinol 2012; 167:7-15. [PMID: 22495491 DOI: 10.1530/eje-11-1013] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The prevalence of primary aldosteronism in unselected hypertensive patients is currently unknown. We investigated the frequency of positive screening results for primary aldosteronism based on the aldosterone-to-renin ratio (ARR) in hypertensive subjects aged 30-79 years from two German epidemiological studies. We further examined the frequency of positive screening results in subjects with resistant hypertension or stage III hypertension and assessed possible disparities between untreated and treated hypertensive subjects. METHODS Data were obtained from the first follow-ups of the population-based study of health in Pomerania (SHIP; n=1392) and the cooperative health research in the region of Augsburg (KORA; n=1052). Study-specific reference ranges for plasma aldosterone concentration (PAC), plasma renin concentration (PRC) and the ARR were applied. Confirmation tests for primary aldosteronism were not performed in these epidemiological studies.Three definitions for a positive screening for primary aldosteronism were applied: A) increased ARR; B) increased ARR and decreased PRC; and C) increased ARR and increased PAC and decreased PRC. RESULTS The frequency of positive screening results was 7.0, 3.8 and 0.2% according to definitions A-C respectively. In the subgroups of subjects with resistant hypertension (11.9, 5.5 and 0.9%) or stage III hypertension (18.3, 14.0 and 1.1%), these frequencies were markedly higher than those in the general hypertensive population. There was no difference in the frequency of positive screening results between the treated and untreated hypertensive subjects. CONCLUSIONS A maximum of 7.0% of the hypertensive population in Germany shows a positive screening result for primary aldosteronism. Thus, primary aldosteronism may be less frequent than previously expected based on data from referred hypertensive patients.
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Affiliation(s)
- A Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Strasse, D-17475 Greifswald, Germany.
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Michel FS, Norton GR, Majane OH, Badenhorst M, Vengethasamy L, Paiker J, Maseko MJ, Sareli P, Woodiwiss AJ. Contribution of Circulating Angiotensinogen Concentrations to Variations in Aldosterone and Blood Pressure in a Group of African Ancestry Depends on Salt Intake. Hypertension 2012; 59:62-9. [DOI: 10.1161/hypertensionaha.111.181230] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Frederic S. Michel
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), 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 (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), 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 (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Margaret Badenhorst
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Leanda Vengethasamy
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janice Paiker
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), 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 (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinhas Sareli
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), 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 (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Calhoun DA, White WB, Krum H, Guo W, Bermann G, Trapani A, Lefkowitz MP, Ménard J. Effects of a Novel Aldosterone Synthase Inhibitor for Treatment of Primary Hypertension. Circulation 2011; 124:1945-55. [DOI: 10.1161/circulationaha.111.029892] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background—
LCI699, a novel inhibitor of aldosterone synthase, reduces serum aldosterone, and may have benefit in the treatment of hypertension.
Methods and Results—
We performed the first double-blind, randomized trial with LCI699 in patients with primary hypertension. We randomized 524 patients to LCI699 0.25 mg once daily (n=92), 0.5 mg once daily (n=88), 1.0 mg once daily (n=86), and 0.5 mg twice daily (n=97); eplerenone 50 mg twice daily (n=84); or placebo (n=77) for 8 weeks. Adrenocorticotropic hormone (250 μg IV) stimulation testing was performed in a subset of patients to quantify the selectivity of LCI699 for aldosterone synthase compared with 11-β-hydroxylase. Reductions in clinic diastolic blood pressure were significant for LCI699 1.0 mg (−7.1 mm Hg;
P
=0.0012) and eplerenone 50 mg twice daily (−7.9 mm Hg;
P
<0.0001) compared with placebo (−2.6 mm Hg) but not other doses of LCI699. Significant reductions in clinic systolic blood pressure were observed with all doses of LCI699 (
P
<0.005 or better) and eplerenone (
P
<0.0001). All doses of LCI699 significantly reduced 24-hour ambulatory blood pressure compared with placebo (
P
<0.01). Adrenocorticotropic hormone stimulation of cortisol was suppressed in ≈20% of subjects receiving LCI699 at a total daily dose of 1.0 mg. Safety and tolerability were similar among LCI699, placebo, and eplerenone.
Conclusions—
Aldosterone synthase inhibition with LCI699 significantly lowered clinic and ambulatory blood pressure. A minority of subjects developed blunted adrenocorticotropic hormone–stimulated release of cortisol. These results support additional research to evaluate use of aldosterone synthase inhibition in primary hypertension and/or patients characterized by aldosterone excess.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00758524.
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Affiliation(s)
- David A. Calhoun
- From the Vascular Biology and Hypertension Program, University of Alabama at Birmingham (D.A.C.); Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Center of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (H.K.); Novartis Pharmaceuticals Corporation, East Hanover, NJ (W.G., A.T., M.P.L.)
| | - William B. White
- From the Vascular Biology and Hypertension Program, University of Alabama at Birmingham (D.A.C.); Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Center of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (H.K.); Novartis Pharmaceuticals Corporation, East Hanover, NJ (W.G., A.T., M.P.L.)
| | - Henry Krum
- From the Vascular Biology and Hypertension Program, University of Alabama at Birmingham (D.A.C.); Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Center of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (H.K.); Novartis Pharmaceuticals Corporation, East Hanover, NJ (W.G., A.T., M.P.L.)
| | - Weinong Guo
- From the Vascular Biology and Hypertension Program, University of Alabama at Birmingham (D.A.C.); Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Center of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (H.K.); Novartis Pharmaceuticals Corporation, East Hanover, NJ (W.G., A.T., M.P.L.)
| | - Georgina Bermann
- From the Vascular Biology and Hypertension Program, University of Alabama at Birmingham (D.A.C.); Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Center of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (H.K.); Novartis Pharmaceuticals Corporation, East Hanover, NJ (W.G., A.T., M.P.L.)
| | - Angelo Trapani
- From the Vascular Biology and Hypertension Program, University of Alabama at Birmingham (D.A.C.); Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Center of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (H.K.); Novartis Pharmaceuticals Corporation, East Hanover, NJ (W.G., A.T., M.P.L.)
| | - Martin P. Lefkowitz
- From the Vascular Biology and Hypertension Program, University of Alabama at Birmingham (D.A.C.); Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Center of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (H.K.); Novartis Pharmaceuticals Corporation, East Hanover, NJ (W.G., A.T., M.P.L.)
| | - Joël Ménard
- From the Vascular Biology and Hypertension Program, University of Alabama at Birmingham (D.A.C.); Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington (W.B.W.); Center of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (H.K.); Novartis Pharmaceuticals Corporation, East Hanover, NJ (W.G., A.T., M.P.L.)
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Aldosterone-to-renin ratio and nocturnal blood pressure decline in a general population. J Hypertens 2011; 29:1940-7. [DOI: 10.1097/hjh.0b013e32834ab46a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aldosterone-to-renin ratio and the relationship between urinary salt excretion and blood pressure in a community of African ancestry. Am J Hypertens 2011; 24:951-7. [PMID: 21451591 DOI: 10.1038/ajh.2011.49] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although aldosterone influences the effect of salt intake on blood pressure (BP), the extent to which this occurs at a population level is uncertain. We therefore aimed to determine, at a community level in a group of African descent, whether in the absence of primary aldosteronism, the relationship between salt intake and BP is modified by circulating aldosterone, and the extent to which this occurs. METHODS In 575 participants of African ancestry (age >16 years), we assessed whether aldosterone-to-renin ratio (ARR) is associated with the relationship between urinary sodium (Na(+))-to-potassium (K(+)) ratio (urinary Na(+)/K(+)) (from 24-h urine samples), an index of salt intake, and BP. RESULTS With adjustments for confounders, interactions between ARR and urinary Na(+)/K(+) were independently associated with systolic BP (SBP) (P < 0.0001), an effect that was accounted for by interactions between serum aldosterone concentrations and urinary Na(+)/K(+) (P < 0.0001), but not between plasma renin concentrations and urinary Na(+)/K(+) (P = 0.52). The interaction between ARR and urinary Na(+)/K(+) translated into a marked difference in the relationship between urinary Na(+)/K(+) and SBP in participants above compared to below the median for ARR (effect of 1 s.d. increase in urinary Na(+)/K(+) on SBP: ARR > median = 4.2 ± 0.6 mm Hg; ARR < median = 1.2 ± 0.4 mm Hg, P < 0.0001). In addition, participants with urinary Na(+)/K(+) above the median had higher multivariate-adjusted SBP (P < 0.001) only if ARR was also above the median. CONCLUSIONS In groups of African descent, in the absence of primary aldosteronism, an increased aldosterone concentration relative to renin modifies a substantial proportion of the relationship between urinary Na(+)/K(+) and BP at a community level.
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Positive relationship of sleep apnea to hyperaldosteronism in an ethnically diverse population. J Hypertens 2011; 29:1553-9. [DOI: 10.1097/hjh.0b013e3283492219] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Wrobel MJ, Figge JJ, Izzo JL. Hypertension in diverse populations: a New York State Medicaid clinical guidance document. ACTA ACUST UNITED AC 2011; 5:208-29. [DOI: 10.1016/j.jash.2011.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 05/14/2011] [Indexed: 02/07/2023]
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Kidambi S, Kotchen JM, Krishnaswami S, Grim CE, Kotchen TA. Cardiovascular correlates of insulin resistance in normotensive and hypertensive African Americans. Metabolism 2011; 60:835-42. [PMID: 20846700 PMCID: PMC3020994 DOI: 10.1016/j.metabol.2010.07.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 07/29/2010] [Accepted: 07/30/2010] [Indexed: 11/29/2022]
Abstract
Insulin resistance (IR) is associated with obesity and predisposes to diabetes mellitus (DM) and cardiovascular disease. The purpose of this study is to determine if IR is related to cardiovascular function independent of DM or hypertension among African Americans (AA). Four hundred sixty-two nondiabetic AA (50% hypertensive and 51% women) were studied on an inpatient General Clinical Research Center. Measurements included anthropometrics and 24-hour blood pressure (BP), heart rate (HR), fasting blood glucose, plasma aldosterone, and insulin. Stroke volume (SV) and cardiac output (CO) were measured by impedance plethysmography; peripheral vascular resistance (PVRI) and vascular compliance indices (VCI) were computed. These measurements were also obtained in response to mental (computerized math testing) and pharmacologic (graded norepinephrine infusion) stress. Insulin resistance was calculated using the homeostasis model assessment (HOMA-IR). SV, CO, and VCI decreased with increasing HOMA-IR, whereas HR and PVRI increased. Overall, BP, HR, and PVRI were positively correlated with HOMA-IR (P < .01); and SV index, cardiac index, and VCI were negatively correlated with HOMA-IR (P < .0001). The correlations persisted after adjustment for BP, age, sex, plasma aldosterone, total cholesterol, or low-density lipoprotein and high-density lipoprotein cholesterol. In addition, multiple linear regression analyses showed that HOMA-IR contributes to the maximum variability of all the hemodynamic variables. Blood pressure responses to math stress and norepinephrine infusion did not correlate with HOMA-IR. Unrelated to DM and BP, IR is associated with increased PVRI and decreased CO in AA. These observations suggest that an exclusive focus on effects of IR on DM or BP may ignore independent pathophysiologic contributions of IR to cardiovascular disease.
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Hannemann A, Meisinger C, Bidlingmaier M, Döring A, Thorand B, Heier M, Belcredi P, Ladwig KH, Wallaschofski H, Friedrich N, Schipf S, Lüdemann J, Rettig R, Peters J, Völzke H, Seissler J, Beuschlein F, Nauck M, Reincke M. Association of plasma aldosterone with the metabolic syndrome in two German populations. Eur J Endocrinol 2011; 164:751-8. [PMID: 21357289 DOI: 10.1530/eje-10-1074] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the potential association of the plasma aldosterone concentration (PAC) with the metabolic syndrome (MetS) and its components in two German population-based studies. METHODS We selected 2830 and 2901 participants (31-80 years) from the follow-ups of the Study of Health in Pomerania (SHIP)-1 and the Cooperative Health Research in the Region of Augsburg (KORA) F4 respectively. MetS was defined as the presence of at least three out of the following five criteria: waist circumference ≥94 cm (men (m)) and ≥80 cm (women (w)); high-density lipoprotein (HDL) cholesterol <1.0 mmol/l (m) and <1.3 mmol/l (w); blood pressure ≥130/85 mmHg or antihypertensive treatment; non-fasting glucose (SHIP-1) ≥8 mmol/l, fasting glucose (KORA F4) ≥5.55 mmol/l or antidiabetic treatment; non-fasting triglycerides (SHIP-1) ≥2.3 mmol/l, fasting triglycerides (KORA F4) ≥1.7 mmol/l, or lipid-lowering treatment. We calculated logistic regression models by comparing the highest study- and sex-specific PAC quintiles versus all lower quintiles. RESULTS MetS was common with 48.1% (m) and 34.8% (w) in SHIP-1 and 42.7% (m) and 27.5% (w) in KORA F4. Our logistic regression models revealed associations of PAC with MetS, elevated triglycerides, and decreased HDL cholesterol in SHIP-1 and KORA F4. CONCLUSIONS Our findings add to the increasing evidence supporting a relation between aldosterone and MetS and suggest that aldosterone may be involved in the pathophysiology of MetS and lipid metabolism disorders.
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Affiliation(s)
- Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Strasse, Greifswald, Germany.
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Tsioufis C, Kordalis A, Flessas D, Anastasopoulos I, Tsiachris D, Papademetriou V, Stefanadis C. Pathophysiology of resistant hypertension: the role of sympathetic nervous system. Int J Hypertens 2011; 2011:642416. [PMID: 21331155 PMCID: PMC3034926 DOI: 10.4061/2011/642416] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 12/22/2010] [Indexed: 11/20/2022] Open
Abstract
Resistant hypertension (RH) is a powerful risk factor for cardiovascular morbidity and mortality. Among the characteristics of patients with RH, obesity, obstructive sleep apnea, and aldosterone excess are covering a great area of the mosaic of RH phenotype. Increased sympathetic nervous system (SNS) activity is present in all these underlying conditions, supporting its crucial role in the pathophysiology of antihypertensive treatment resistance. Current clinical and experimental knowledge points towards an impact of several factors on SNS activation, namely, insulin resistance, adipokines, endothelial dysfunction, cyclic intermittent hypoxaemia, aldosterone effects on central nervous system, chemoreceptors, and baroreceptors dysregulation. The further investigation and understanding of the mechanisms leading to SNS activation could reveal novel therapeutic targets and expand our treatment options in the challenging management of RH.
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Affiliation(s)
- Costas Tsioufis
- First Cardiology Clinic, University of Athens, Hippokration Hospital, 3 Kolokotroni Street, P. Penteli, Athens 15236, Greece
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Brady TM, Fivush B, Parekh RS, Flynn JT. Racial differences among children with primary hypertension. Pediatrics 2010; 126:931-7. [PMID: 20956429 DOI: 10.1542/peds.2009-2972] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Race is a known risk factor for hypertension and cardiovascular disease in adults and influences blood pressure (BP) in children. We sought to determine if there are differences in clinical, laboratory, or echocardiographic characteristics among children with primary hypertension from different racial groups. PATIENTS AND METHODS Study participants were 184 children aged 3 to 20 years with a diagnosis of primary hypertension who were examined at 1 of 3 participating centers at the time of initial evaluation of elevated BP. Black children were categorized as African American (AA) and nonblack children as non-AA. Comparisons were made for the entire group and after stratification according to age (<13 or ≥ 13 years). RESULTS Overall, children categorized as AA had a higher prevalence of overweight/obesity and left ventricular hypertrophy and had higher plasma renin activity than children who were categorized as non-AA. After age stratification, these differences remained only in the children younger than 13 years old; there were no differences in these findings among children aged 13 years or older. AA children who were aged 13 years or older, however, had higher BPs for both casual and ambulatory measurements. Specifically, they had higher casual diastolic BP, higher 24-hour diastolic BP, higher daytime systolic and diastolic BP, and higher BP loads at night and over a 24-hour period compared with non-AA children who were aged 13 years or older. CONCLUSIONS These data indicate that black children with primary hypertension may be at increased cardiovascular risk compared with nonblack children with primary hypertension. However, the high prevalence of overweight/obesity and left ventricular hypertrophy in all youth with primary hypertension demonstrates the need for greater preventive and therapeutic efforts aimed at reducing cardiovascular risk in this vulnerable population.
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Affiliation(s)
- Tammy M Brady
- Division of Pediatric Nephrology, Department of Pediatrics, Johns Hopkins University, 200 N Wolfe St, 3062, Baltimore, MD 21287, USA.
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Nitta K. Possible Link between Metabolic Syndrome and Chronic Kidney Disease in the Development of Cardiovascular Disease. Cardiol Res Pract 2010; 2011. [PMID: 20953380 PMCID: PMC2952942 DOI: 10.4061/2011/963517] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 09/06/2010] [Indexed: 11/20/2022] Open
Abstract
Metabolic syndrome (MetS) is a clinical syndrome that consists of visceral obesity, dyslipidemia, hypertension, and impaired insulin sensitivity. Although individual components of MetS have been implicated in the development of chronic kidney disease (CKD), few studies have examined the effect of combinations of the components of MetS on the development of CKD and cardiovascular disease (CVD). The prevalence of MetS is increasing worldwide in both developing and developed countries, and early detection and treatment of MetS would be a cost-effective strategy for preventing the development of CKD. Visceral obesity and insulin resistance are two important features of MetS that may be associated with renal damage. Lifestyle modifications, including caloric restriction and exercise, are necessary to treat MetS. Initial antihypertensive therapy should consist of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. An improved understanding of the mechanism responsible for the association between MetS and renal damage should be helpful in determining the treatment regimens directed at cardiovascular and renal protection.
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Affiliation(s)
- Kosaku Nitta
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
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50
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Abstract
A large body of evidence strongly links aldosterone to development and progression of cardiovascular disease, including vascular stiffness, left ventricular hypertrophy, congestive heart failure, chronic kidney disease, and, especially, hypertension. Emerging data suggest that adipocytes may serve as a source of aldosterone, either directly or indirectly, through the release of aldosterone-stimulating factors. If adipocytes are confirmed to have an important contribution to hyperaldosteronism, it would have significant clinical implications in linking aldosterone to obesity-related increases in cardiovascular risk. Such a cause-and-effect situation would then provide the opportunity to reverse that risk with preferential use of aldosterone antagonists in obese patients.
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