Joshua J Joseph1, Neal K Pohlman1, Songzhu Zhao1, David Kline1, Guy Brock1, Justin B Echouffo-Tcheugui2, Mario Sims3,4, Valery S Effoe5, Wen-Chih Wu6, Rita R Kalyani2, Gary S Wand2, Bjorn Kluwe1, Willa A Hsueh1, Marwah Abdalla, Daichi Shimbo4, Sherita H Golden2. 1. The Ohio State University College of Medicine, Columbus (J.J.J., N.K.P., S.Z., D.K., G.B., B.K., W.A.H.). 2. Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD (J.B.E.-T., R.R.K., G.S.W., S.H.C.). 3. Department of Medicine, University of Mississippi Medical Center, Jackson (M.S.). 4. Division of Cardiology, Columbia University, New York (M.S., D.S.). 5. Department of Medicine, Morehouse School of Medicine, Atlanta, GA (V.S.E.). 6. Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (W.-C.W.).
Abstract
BACKGROUND: The renin-angiotensin-aldosterone system (RAAS) is an important driver of blood pressure (BP), but the association of the RAAS with ambulatory BP (ABP) and ABP monitoring phenotypes among African Americans has not been assessed. METHODS: ABP and ABP monitoring phenotypes were assessed in 912 Jackson Heart Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analyses were used to analyze the association of aldosterone and PRA with clinic, awake, and asleep systolic BP and diastolic BP (DBP) and ABP monitoring 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 systolic BP 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 (odds ratio [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 was associated with percent dipping, nondipping BP pattern, or white-coat hypertension. Patterns for aldosterone:renin ratio were similar to patterns for PRA. CONCLUSIONS: Suppressed renin activity and higher aldosterone:renin ratios were associated with higher systolic BP and DBP in the office and during the awake and asleep periods as evidenced by ABP monitoring. Higher aldosterone levels were associated with higher DBP, but not systolic BP, 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 African Americans.
BACKGROUND: The renin-angiotensin-aldosterone system (RAAS) is an important driver of blood pressure (BP), but the association of the RAAS with ambulatory BP (ABP) and ABP monitoring phenotypes among African Americans has not been assessed. METHODS: ABP and ABP monitoring phenotypes were assessed in 912 Jackson Heart Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analyses were used to analyze the association of aldosterone and PRA with clinic, awake, and asleep systolic BP and diastolic BP (DBP) and ABP monitoring 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 systolic BP 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 (odds ratio [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 was associated with percent dipping, nondipping BP pattern, or white-coat hypertension. Patterns for aldosterone:renin ratio were similar to patterns for PRA. CONCLUSIONS: Suppressed renin activity and higher aldosterone:renin ratios were associated with higher systolic BP and DBP in the office and during the awake and asleep periods as evidenced by ABP monitoring. Higher aldosterone levels were associated with higher DBP, but not systolic BP, 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 African Americans.
Authors: Joshua J Joseph; Justin B Echouffo-Tcheugui; Rita R Kalyani; Hsin-Chieh Yeh; Alain G Bertoni; Valery S Effoe; Ramon Casanova; Mario Sims; Adolfo Correa; Wen-Chih Wu; Gary S Wand; Sherita H Golden Journal: J Clin Endocrinol Metab Date: 2016-02-23 Impact factor: 5.958
Authors: Emelia J Benjamin; Paul Muntner; Alvaro Alonso; Marcio S Bittencourt; Clifton W Callaway; April P Carson; Alanna M Chamberlain; Alexander R Chang; Susan Cheng; Sandeep R Das; Francesca N Delling; Luc Djousse; Mitchell S V Elkind; Jane F Ferguson; Myriam Fornage; Lori Chaffin Jordan; Sadiya S Khan; Brett M Kissela; Kristen L Knutson; Tak W Kwan; Daniel T Lackland; Tené T Lewis; Judith H Lichtman; Chris T Longenecker; Matthew Shane Loop; Pamela L Lutsey; Seth S Martin; Kunihiro Matsushita; Andrew E Moran; Michael E Mussolino; Martin O'Flaherty; Ambarish Pandey; Amanda M Perak; Wayne D Rosamond; Gregory A Roth; Uchechukwu K A Sampson; Gary M Satou; Emily B Schroeder; Svati H Shah; Nicole L Spartano; Andrew Stokes; David L Tirschwell; Connie W Tsao; Mintu P Turakhia; Lisa B VanWagner; John T Wilkins; Sally S Wong; Salim S Virani Journal: Circulation Date: 2019-03-05 Impact factor: 29.690
Authors: Joshua J Joseph; Justin B Echouffo-Tcheugui; Rita R Kalyani; Hsin-Chieh Yeh; Alain G Bertoni; Valery S Effoe; Ramon Casanova; Mario Sims; Wen-Chih Wu; Gary S Wand; Adolfo Correa; Sherita H Golden Journal: JACC Heart Fail Date: 2017-08-16 Impact factor: 12.035
Authors: José R Banegas; Luis M Ruilope; Alejandro de la Sierra; Ernest Vinyoles; Manuel Gorostidi; Juan J de la Cruz; Gema Ruiz-Hurtado; Julián Segura; Fernando Rodríguez-Artalejo; Bryan Williams Journal: N Engl J Med Date: 2018-04-19 Impact factor: 91.245
Authors: Dena E Rifkin; Ali R Khaki; Nancy S Jenny; Robyn L McClelland; Matthew Budoff; Karol Watson; Joachim H Ix; Matthew A Allison Journal: Am J Hypertens Date: 2014-01-16 Impact factor: 2.689