Recent studies have reported a high prevalence of primary aldosteronism among patients with severe hypertension. However, the prevalence of this disease among normotensive and mildly hypertensive patients has not been determined. The aim of this study was to examine the prevalence of primary aldosteronism among prehypertensive and stage 1 hypertensive subjects. A total of 292 adult subjects with hypertension or prehypertension was screened for primary aldosteronism. Subjects with a plasma aldosterone concentration (ng per 100 ml) to plasma renin activity (ng ml -1 h -1 ) ratio (ARR) above 20 underwent confirmatory captopril suppression testing. A total of 54 subjects (18.5%) had an ARR above 20. A captopril suppression test was performed in 17 of 54 subjects with probable primary aldosteronism. The test confirmed the diagnosis of primary aldosteronism in 11 (64.7%) of 17 patients, giving a least prevalence of 3.8% for this disease. The 11 patients with primary aldosteronism had a mean ± s.d. systolic blood pressure of 139 ± 4 mm Hg, diastolic blood pressure of 95 ± 10 mm Hg and serum potassium of 4.46 ± 0.48 mEq l -1 at the time of screening test. The prevalence of primary aldosteronism as could be assessed in this study was at least 6.8% in prehypertensive patients, 3.3% in stage 1 hypertensive patients and 3.1% in stage 2 hypertensive patients. In conclusion, this study suggests a high prevalence of primary aldosteronism among prehypertensive and stage 1 hypertensive Japanese patients. Significant numbers of prehypertensive individuals may have subclinical forms of this disease.

Our novel QCA was rapidly and easily performed at the point of care and improved the rate of successful AVS.

A ngiotensinogen (AGT; serpin peptidase inhibitor, clade A, member 8) is a glycoprotein that is the primary substrate of the renin-angiotensin-aldosterone system (RAAS) and is, therefore, one of the most frequently studied proteins because of its contributions to hypertension. Given that AGT is the primary substrate controlling the rate-limiting step of the production of angiotensin peptides, a rise in AGT levels can lead to a parallel increase in the formation of the physiologically active enzyme angiotensin II and may ultimately result in multiple diseases, such as hypertension, cardiovascular disease, and kidney injury. 1-3The AGT gene is expressed in many human tissues, as determined by an analysis of cDNA sequences available on the Unigene website. The AGT gene is known to be highly expressed in the liver, heart, and brain, whereas weakly expressed in the adrenal gland (www.ncbi.nlm.nih.gov/ sites/entrez?db=unigene; Figure S1 in the online-only Data Supplement). The expression of AGT is under developmental and hormonal control in a cell type-specific manner. 4 It is generally approved that AGT expression is predominantly regulated at the transcriptional level. 5 Multiple cis-acting DNA regulatory elements and transcription factors are known to be important in the regulation of AGT. 4,[6][7][8][9] Among those transcription factors, CCAAT/enhancer binding protein (CEBP) has been shown to increase AGT promoter activity through binding to the promoter region 6 and is important for the regulation of AGT in response to interleukin 6 (IL6). 6,10 The CEBP family facilitates the binding of other transcription factors to shared sites and contributes to efficient chromatin remodeling at some of these sites. This feature of CEBP function indicates that it is a pioneering factor for the assembly of transcription factor complexes at these sites. 11Abstract-DNA methylation patterns are maintained in adult somatic cells. Recent findings, however, suggest that all methylation patterns are not preserved. We demonstrate that stimulatory signals can change the DNA methylation status at a CCAAT/enhancer binding protein (CEBP) binding site and a transcription start site and activate expression of the angiotensinogen gene (AGT). A CEBP binding site in the human AGT promoter was hypomethylated in tissues with high expression of AGT, but not in those with low expression. The transcriptional activity of AGT promoter sequences cloned into a reporter plasmid depended on DNA methylation. In cultured human cells, interleukin 6 stimulation caused DNA demethylation around a CEBP binding site and a transcription start site; demethylation was accompanied by increased CEBP-β recruitment and chromatin accessibility of the AGT promoter. DNA methylation activity decreased in the nucleus. Excess circulating aldosterone upregulated AGT expression and was accompanied by DNA hypomethylation around a CEBP binding site and a transcription start site in human visceral adipose tissue. High salt intake led to upregulation of Agt expression, DNA hypometh...