Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study

Abstract

Background: The renin-angiotensin-aldosterone system (RAAS) is an important driver of BP but the association of the RAAS with ambulatory blood pressure (ABP) and ABPM phenotypes among African Americans (AA) has not been assessed. Methods: ABP and ABPM phenotypes were assessed in 912 Jackson Heart Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analysis were used to analyze the association of aldosterone, and PRA with clinic, awake and asleep systolic blood pressure (SBP) and diastolic blood pressure (DBP) and ABPM 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 SBP 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 (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 were associated with percent dipping, non-dipping BP pattern, or white-coat hypertension. Patterns for aldosterone:renin ratio were similar to PRA. Conclusions: Suppressed renin activity and higher aldosterone:renin ratios were associated with both higher SBP and DBP in the office and during the awake and asleep periods as evidenced by ABPM. Higher aldosterone levels were associated with higher DBP, but not SBP, 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 AAs.

Spironolactone effect on the blood pressure of patients at risk of developing heart failure: an analysis from the HOMAGE trial

“…Together, these findings support the "salt retention hypothesis" and suggest that, despite the neurohormonal activation, plasma renin can be suppressed by sodium retention, and spironolactone may be more effective in patients with greater sodium retention and/or higher expression of the mineralocorticoid receptor, as supported by prior studies 10 . Moreover, in HOMAGE patients with lower baseline renin had higher systolic and diastolic BP, similar to the findings of other cohorts [11][12][13][14][15] . Therefore, spironolactone targeting the low renin physiology, can improve BP control 11 .…”

“…Moreover, in HOMAGE patients with lower baseline renin had higher systolic and diastolic BP, similar to the findings of other cohorts [11][12][13][14][15] . Therefore, spironolactone targeting the low renin physiology, can improve BP control 11 .…”

Cardiac Structure and Function Across the Spectrum of Aldosteronism: the Atherosclerosis Risk in Communities Study

“…18 Aldosterone production, especially when renin is suppressed (ie, PA physiology), is common and an independent predictor of hypertension, cardiovascular disease, and death. [19][20][21][22][23] It is unknown whether patients with a phenotype of milder PA physiology have detectable changes in myocardial structure and function, before developing HF.…”

Engineered probiotics Clostridium butyricum‐pMTL007‐GLP‐1 improves blood pressure via producing GLP‐1 and modulating gut microbiota in spontaneous hypertension rat models

“…Hypertension has been identified as one of the major risk factors for many cardiovascular diseases such as myocardial infarction (MI), coronary heart disease (CHD) and apoplexy (van Oort et al, 2020 ). Moreover, apart from renal diseases and ocular hypertension, recent studies have also found correlation between hypertension with certain extra‐cardiovascular diseases including Alzheimer's disease (Carnevale et al, 2020 ; Kivipelto et al, 2018 ) and diabetes mellitus (Joseph et al, 2021 ; Zhang, Hou, et al, 2020 ; Zhang, Nie, et al, 2020 ).…”