Relationship Between Obesity, Hypertension, and Aldosterone Production in Postmenopausal African American Women: A Pilot Study

Abstract

2Increased abdominal obesity is associated with increased cardiovascular risk, especially in African American women. The adipocyte is documented to produce a number of inflammatory factors including the hormone aldosterone. There are very few data documenting aldosterone production from adipocytes of postmenopausal women as well as data demonstrating the effects of angiotensin receptor blockade (ARB) on its production in predominately African American women. The authors hypothesize that increased central adipocyte mass in obese postmenopausal women contributes to increased production of aldosterone that is suppressed with the ARB azilsartan medoxomil. The authors tested this hypothesis in a double-blind, placebo-controlled pilot study of 34 hypertensive postmenopausal women (mean age 57.5AE7.5 years), 91% of whom were African American. Patients had a mean 24-hour ambulatory systolic blood pressure of 127AE13 mm Hg off any blocker of the reninangiotensin system but while taking other antihypertensive medications. The authors further validated aldosterone production in a nested cohort of women using fat cells from a fat pad biopsy. Azilsartan reduced 24-hour urinary aldosterone by 47.3% from baseline (P=.03), with between-groups differences in urine aldosterone of À5.3AE52.3% placebo vs À47.3AE32.9% azilsartan (P=.07) at 6 months. An adrenal cell line treated with adipocyte-conditioned media from subcutaneous abdominal adipocytes of postmenopausal women (n=3) showed an increase in aldosterone production blocked by an ARB (1948AE1297 pg/mL fat alone vs 894AE438 pg/mL fat + ARB; P=.022). The authors conclude that aldosterone is produced from subcutaneous adipocytes of obese postmenopausal women. Moreover, use of an ARB significantly reduces aldosterone production within 6 months of use in these women as well as in cells exposed to their adipocytes.

Sensor‐measured physical activity is associated with decreased cardiovascular disease risk in African Americans

“…The DXA scans provided the participants' total body percent fat, lean body mass (g), total fat mass (g), total bone mass (g), and total fat distribution (ratio of total android fat mass divided by total gynoid fat mass). 23…”

“…Waist‐to‐hip ratio was calculated by dividing the participants’ waist circumference measurement by their hip circumference measurement. The DXA scans provided the participants’ total body percent fat, lean body mass (g), total fat mass (g), total bone mass (g), and total fat distribution (ratio of total android fat mass divided by total gynoid fat mass) 23 . For descriptive reporting purposes only, each participant's blood pressure category was determined according to the American Heart Association definitions where normal is systolic <120 mmHg and diastolic <80 mmHg; elevated is systolic 120‐129 mmHg and diastolic <80 mmHg; stage 1 high blood pressure is systolic 130‐139 mmHg or diastolic 80‐89 mmHg; and stage 2 high blood pressure is systolic 140 mmHg or higher or diastolic is 90 mmHg or higher 24…”

Human Genome Evolution and Development of Cardiovascular Risk Factors Through Natural Selection

“…Indeed, American blacks with the highest quartile of African ancestry have 8 % higher prevalence of hypertension compared to the lowest quartile (Marden et al 2016). Recently, abnormal relationship of aldosterone production in subcutaneous adipocytes with obesity and hypertension was reported in African American subjects (Laffin et al 2016). In the same time the activation of renin-angiotensin-aldosterone system was reported to be associated with insulin resistance and diabetes in African Americans studied in Jackson Heart Study (Joseph et al 2016).…”

Impact of a nutrition and physical activity program in cardiorespiratory, hemodynamic, metabolic and behavior parameters

“…Fat distribution seems to play an important role in the relationship between obesity and cardiovascular disease; and central abdominal obesity becomes a main risk factor contributing to cardiovascular disease risk (Laffin et al, 2016). Besides considerable prevalence of obesity in Spanish population, abdominal obesity is also presented in a very high percentage (51%) in this population (Casanueva et al, 2010).…”

“…Obesity is a complex metabolic disorder (Laffin et al, 2016), which has been considered as a major public health problem (Vallgarda, 2015). Obesity is associated with number of diseases, especially cardiovascular disease, hypertension, dyslipidemia and diabetes; and evidences indicate that even with treatment for mediate these diseases, obese individuals will continue to have significantly raised risk (Lu et al, 2014).…”