Inappropriate Elevation of the Aldosterone/Plasma Renin Activity Ratio in Hypertensive Patients with Increases of 11-Deoxycorticosterone and 18-Hydroxy-ll-Deoxycorticosterone: A Subtype of Essential Hypertension?

Komiya, Ichiro; Yamada, Takashi; Aizawa, Toru; Takasu, Nobuyuki; Niwa, Akihiro; Maruyama, Yuzo; Ogawa, Akimi

doi:10.1159/000174773

Cited by 21 publications

(17 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…CT measurements of the adrenal glands were made to the nearest millimeter and multiplied by an appropriate magnification factor to obtain the true size, according to the method described by Montagne et al [8] ( Fig. 1) with a minor modification [19]. The width of the gland was defined as the greatest linear dimension seen on any single tomographic section (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…1). The length of the gland was defined as its cephalocaudal dimension and was determined by counting the number of sections on which the adrenal gland was visible and multiplying the number by the true interval on the CT scan according a modification of the method [19]. Adrenal measurements in control subjects with Cushing's syndrome or APA were made on the contralateral sides of the adrenal tumors.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Analysis of Adrenocortical Hyperplasia by Computed Tomography in Patients with Cushing's Disease, Idiopathic Hyperaldosteronism and Adrenogenital Syndrome.

et al. 1994

Self Cite

View full text Add to dashboard Cite

Abstract. We assessed the usefulness and reliability of computed tomography (CT scan) in evaluating adrenal hyperplasia in 38 patients, including 14 with Cushing's disease, 17 with idiopathic hyperaldosteronism (IHA), and 7 with the adrenogenital syndrome (AGS). Eighty-two normal subjects were also examined. We analyzed the shape of the adrenal gland and quantitated its thickness, width and length. Visual inspection revealed V-shaped right adrenal glands in 100% of patients with Cushing's disease, 94% of patients with IHA,100% of patients with AGS and in 41% of the normal subjects. Triangular left adrenal glands were observed in 100% of patients with Cushing's disease, 82% of patients with IHA, 67% of patients with AGS and in 12% of the normal subjects. Quantitative analysis showed that the right adrenal gland was significantly thicker and longer in patients with Cushing's disease, IHA and in those with AGS than in normal subjects. The right adrenal gland was significantly wider in the patients with Cushing's disease and AGS than in control subjects. The left adrenal gland was significantly wider and longer in patients with Cushing's disease and AGS than in the normal controls. Analysis of individual data indicated that the upper limit of normal for thickness of the right adrenal was 7 mm. Therefore, adrenal hyperplasia was strongly suggested when the right adrenal gland was more than 7 mm thick. Our findings suggest that the CT scan is useful and reliable in diagnosing adrenal hyperplasia.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Analysis of Adrenocortical Hyperplasia by Computed Tomography in Patients with Cushing's Disease, Idiopathic Hyperaldosteronism and Adrenogenital Syndrome.

et al. 1994

Self Cite

View full text Add to dashboard Cite

show abstract

“…We have reported that 12.4% of 436 Japanese hypertensive patients had low plasma renin activity (PRA) combined with a normal plasma aldosterone concentration (PAC), resulting in an elevated ratio of PAC to PRA (PAC/PRA), 5,6 and we found that so-called pressure natriuresis was incomplete in this subgroup of patients. 6,7 The inappropriate elevation of aldosterone in such hypertensive individuals suggests persistent mineralocorticoid synthesis despite minimal stimulation of RAS.…”

mentioning

confidence: 86%

“…14 Under normal conditions, the PAC was 110 to 555 pmol/L, and the PAC/PRA ratio was Ͻ830 pmol/L per ng ⅐ mL Ϫ1 ⅐ h Ϫ1 . 5,6,14 To facilitate analysis, hypertensive patients were divided into groups with elevated PAC/PRA ratios (low-renin hypertension) or normal to low PAC/PRA ratios (normalor high-renin hypertension). 5,6 Detection of CYP11B2 Gene Polymorphisms Genomic DNA was prepared from peripheral white blood cells according to a standard column extraction technique (Qiagen).…”

Section: Pac/pra Ratiomentioning

confidence: 99%

Lys ¹⁷³ Arg and −344T/C Variants of CYP11B2 in Japanese Patients With Low-Renin Hypertension

et al. 2000

Self Cite

View full text Add to dashboard Cite

Abstract-We analyzed the association of 2 biallelic polymorphisms of CYP11B2 (P450c11AS) gene (1 in the Lys 173 Arg of exon 3 and the other in the promoter at position Ϫ344T/C) with hypertension in 73 hypertensive patients and 134 normotensive subjects. The association between low-renin hypertension and angiotensin I-converting enzyme (ACE) gene was also analyzed. An elevated ratio of plasma aldosterone concentration to plasma renin activity was used to identify low-renin hypertension. Genotypes for CYP11B2 and ACE were determined through polymerase chain reactions. The Arg 173 allele frequency did not differ between hypertensive patients considered as 1 group (34%) and normotensive control subjects (37%). However, only 22% of 58 CYP11B2 alleles studied in 29 patients with low-renin hypertension were Arg 173 alleles, whereas the frequency of this allele was 41% in patients with normal-or high-renin hypertension (Pϭ0.033). An analysis of the distribution of Ϫ344C and Arg 173 genotypes indicated that these 2 variants were in complete linkage disequilibrium: Ϫ344C was present in a subset of chromosomes carrying the Arg 173 (PϽ0.001 in low-renin hypertension). Therefore, the frequency of the Ϫ344C allele was low in the patients with low-renin hypertension compared with those with normal-or high-renin hypertension. Deletion (D) allele frequencies of the ACE gene were 31% in the patients with low-renin hypertension, 39% in the patients with normal-or high-renin hypertension, and 29% in normotensive control subjects. We detected an association between the CYP11B2 gene polymorphisms and low-renin hypertension with inappropriate elevation of aldosterone. The decreased frequencies of the Arg 173 and Ϫ344C variants in the CYP11B2 appear to be genetically linked to low-renin hypertension in the Japanese population studied. Key Words: hypertension, essential Ⅲ cytochrome P-450 Ⅲ polymorphism Ⅲ aldosterone Ⅲ renin-angiotensin system E ssential hypertension is thought to be a polygenic disease. Many gene polymorphisms have been proposed as possible markers for hypertension, including insertion/deletion (I/D) polymorphism of the angiotensin I-converting enzyme (ACE) gene, 1 A1161C polymorphism of the angiotensin II type I receptor gene, 2 and M235T angiotensinogen polymorphism. 3,4 The renin-angiotensin-aldosterone system (RAS) is a key mechanism in the regulation of blood pressure. In addition to the vasoactive action, angiotensin II is a potent stimulus of aldosterone synthesis, which results in sodium and water retention.We have reported that 12.4% of 436 Japanese hypertensive patients had low plasma renin activity (PRA) combined with a normal plasma aldosterone concentration (PAC), resulting in an elevated ratio of PAC to PRA (PAC/PRA), 5,6 and we found that so-called pressure natriuresis was incomplete in this subgroup of patients. 6,7 The inappropriate elevation of aldosterone in such hypertensive individuals suggests persistent mineralocorticoid synthesis despite minimal stimulation of RAS. The biosynthesis of aldosteron...

show abstract

“…Approximately 10% to 20% of patients with essential hypertension exhibit high ALD/PRA. In a study by Komiya et al, 1 which characterized the renin profile in 421 Japanese patients with essential hypertension, 39 patients exhibited a high (Ͼ30) ALD/PRA. The genes for the enzymes involved in aldosterone biosynthesis may contribute to low-renin hypertension.…”

mentioning

confidence: 99%

Genetic Polymorphism of CYP11B2 Gene and Hypertension in Japanese

et al. 1999

View full text Add to dashboard Cite

Abstract-Low-renin hypertension is characterized by a high ratio of aldosterone to plasma renin activity (ALD/PRA), which may suggest inappropriately increased aldosterone biosynthesis. The genes for the enzymes involved in aldosterone synthesis may contribute to low-renin hypertension. We investigated the associations between genetic variations of CYP11B2 (aldosterone synthase) T(Ϫ344)C and hypertension in 482 Japanese subjects. Subjects older than 50 years with a blood pressure Ͻ140/85 mm Hg were considered normotensive (nϭ227 subjects), and subjects younger than 65 years old with a BP Ͼ160/95 mm Hg were considered hypertensive (nϭ255 subjects). The frequency of the TCϩCC genotypes in the normotensive group was significantly lower than in the hypertensive group. Logistic analysis on 482 subjects revealed that body mass index, gender, and the genotype of CYP11B2 T(Ϫ344)C were significantly associated with hypertension. ALD and PRA were assessed in 97 subjects with hypertension, and the TCϩCC genotypes were significantly associated with higher ALD/PRA. Sixty-five subjects with hypertension were assessed by 24-hour ambulatory blood pressure monitoring, and the frequency of nondippers (a difference in mean blood pressure of Ͻ10% between the daytime [6 AM to 9 PM] and nighttime [9 PM to 6 AM] hours) was significantly higher in subjects with the TCϩCC (heteroϩhomo mutation) genotype than in subjects with the TT (wild-type) genotype. Echocardiographic assessment (nϭ136) revealed that the ratio of left ventricular end-diastolic dimension to height tended to be higher in subjects with the TCϩCC genotype than in subjects with the TT genotype. The present study suggests that the (Ϫ344)C allele of the CYP11B2 gene may be a genetic marker for low-renin hypertension in Japanese. Key Words: genetics Ⅲ CYP11B2 Ⅲ aldosterone Ⅲ renin Ⅲ blood pressure monitoring, ambulatory Ⅲ hypertension, low-renin L ow-renin hypertension is characterized by high ratio of aldosterone to plasma renin activity (ALD/PRA), which may suggest inappropriately increased aldosterone biosynthesis. Approximately 10% to 20% of patients with essential hypertension exhibit high ALD/PRA. In a study by Komiya et al, 1 which characterized the renin profile in 421 Japanese patients with essential hypertension, 39 patients exhibited a high (Ͼ30) ALD/PRA. The genes for the enzymes involved in aldosterone biosynthesis may contribute to low-renin hypertension. Indeed, the genetic variant (Lys173Arg) P450c11AS (aldosterone synthase) has been suggested to be involved in low-renin hypertension in Chilean patients. 2 Several frequent polymorphisms have recently been described in the transcriptional regulatory region of the CYP11B2 gene, and the T(Ϫ344)C polymorphism has recently been reported to be associated with left ventricular mass in young Finnish adults free of clinical heart diseases. 3 Pojoga et al 4 reported that the T(Ϫ344)C polymorphism in the aldosterone synthase gene was associated with significant differences in plasma aldosterone levels. However, they rep...

show abstract

Inappropriate Elevation of the Aldosterone/Plasma Renin Activity Ratio in Hypertensive Patients with Increases of 11-Deoxycorticosterone and 18-Hydroxy-ll-Deoxycorticosterone: A Subtype of Essential Hypertension?

Cited by 21 publications

References 18 publications

Analysis of Adrenocortical Hyperplasia by Computed Tomography in Patients with Cushing's Disease, Idiopathic Hyperaldosteronism and Adrenogenital Syndrome.

Analysis of Adrenocortical Hyperplasia by Computed Tomography in Patients with Cushing's Disease, Idiopathic Hyperaldosteronism and Adrenogenital Syndrome.

Lys ¹⁷³ Arg and −344T/C Variants of CYP11B2 in Japanese Patients With Low-Renin Hypertension

Genetic Polymorphism of CYP11B2 Gene and Hypertension in Japanese

Contact Info

Product

Resources

About

Inappropriate Elevation of the Aldosterone/Plasma Renin Activity Ratio in Hypertensive Patients with Increases of 11-Deoxycorticosterone and 18-Hydroxy-ll-Deoxycorticosterone: A Subtype of Essential Hypertension?

Cited by 21 publications

References 18 publications

Analysis of Adrenocortical Hyperplasia by Computed Tomography in Patients with Cushing's Disease, Idiopathic Hyperaldosteronism and Adrenogenital Syndrome.

Analysis of Adrenocortical Hyperplasia by Computed Tomography in Patients with Cushing's Disease, Idiopathic Hyperaldosteronism and Adrenogenital Syndrome.

Lys 173 Arg and −344T/C Variants of CYP11B2 in Japanese Patients With Low-Renin Hypertension

Genetic Polymorphism of CYP11B2 Gene and Hypertension in Japanese

Contact Info

Product

Resources

About

Lys ¹⁷³ Arg and −344T/C Variants of CYP11B2 in Japanese Patients With Low-Renin Hypertension