Changes in Endocrine Activities Relative to Obesity in Patients with Essential Hypertension*

Abstract

The possible role of obesity in the development of hypertension was investigated in two study groups. In a population study of 961 subjects, 739 were found to be normotensive and 222 hypertensive. The prevalence of hypertension was 18.7 percent in the nonobese, and 33.2 percent in the obese subjects. Systolic and diastolic blood pressures increased progressively with the increase of relative body weight in both normotensive and hypertensive subjects. In addition, an endocrinologic study was made of 97 patients with essential hypertension; in 82, plasma renin activity (PRA) was inversely correlated with the increase of relative body weight but not with urinary Na excretion. Despite this decrease of PRA, the level of serum aldosterone was not influenced by relative body weight. Thus, the aldosterone/PRA ratio ratio increased progressively with the increase of relative body weight. Thiazide therapy normalized this inappropriately high ratio, and reduced body weight and blood pressure. Restriction of dietary calories and salt intake had a similar effect. With a high-salt intake in an obese subject, the aldosterone/PRA ratio is unduly increased. Apparently aldosterone contributes to the additional retention of sodium and water and thereby promotes hypertension in the presence of an expanded fluid volume.

Visceral Obesity and Insulin Resistance Are Associated with Plasma Aldosterone Levels in Women

“…Hiramatsu and co-workers studied 96 1 subjects and found that the aldosteronePRA ratio increased with body weight (30). The aldosteronePRA ratio was 77 in the leanest and 187 in the heaviest of their quintiles.…”

Mechanisms of hypertension in the overweight.

“…Plasma renin activity (PRA) has been variously reported to be unchanged in obesity 7 M or reduced in inverse proportion to weight. 15 All three laboratories have found the aldosterone concentration in plasma the same in obese hypertensives. Tuck et al 16 and Hiramatsu et al 15 have found that both PRA and aldosterone are reduced during acute weight loss, although aldosterone diminishes to a lesser degree and correlates poorly with change in blood pressure.…”

Very low-density lipoprotein (VLDL)-induced signals mediating aldosterone production

“…Thus, aldosterone/renin ratios are elevated in obese patients (Hiramatsu et al 1981, Rocchini et al 1986, with this association becoming more obvious in obese individuals receiving a high-salt diet, in which renin activity is suppressed (Goodfriend et al 1998). In addition, visceral fat has been suggested to increase aldosterone production (Aneja et al 2004, Krug et al 2007, Fujita 2008, Ronconi et al 2008.…”