Body Mass Index Predicts 24-Hour Urinary Aldosterone Levels in Patients With Resistant Hypertension

Abstract

Prospective studies indicate that hyperaldosteronism is found in 20% of patients with resistant hypertension (RHTN). A small number of observational studies in normotensive and hypertensive patients suggest a correlation between aldosterone levels and obesity while others could not confirm these findings. The correlation between aldosterone levels and body mass index (BMI) in patients with RHTN has not been previously investigated. Our objective was to determine if BMI is positively correlated with plasma aldosterone concentration (PAC), plasma renin activity (PRA), aldosterone-renin ratio (ARR), and 24-hour urinary aldosterone (24-hr UAldo) African-American (AA) and Caucasian patients. We performed a cross-sectional analysis of a large diverse cohort (n=2170) with RHTN. The relation between PAC, PRA, ARR, 24-hr UAldo and BMI was investigated for the entire cohort, by gender, and race (65.3% Caucasian, 40.3% men). We demonstrate that PAC and ARR were significantly correlated to BMI (p<0.0001) across the first three quartiles, but not from the 3rd to 4th quartile of BMI. PRA was not correlated with BMI. 24-hr UAldo was positively correlated across all quartiles of BMI for the cohort (p<0.0001) and when analyzed by gender (men p<0.0001; women p=0.0013) and race (p<0.05), and stronger for men compared to women (r=0.19, p<0.001 versus r=0.05, p=0.431, p=0.028) regardless of race. In both AA and Caucasian patients, aldosterone levels were positively correlated to increasing BMI, with the correlation being more pronounced in AA and Caucasian men. These findings suggest that obesity, particularly the abdominal obesity typical of men, contributes to excess aldosterone in patients with RHTN.

Eplerenone Implantation Improved Adipose Dysfunction Averting RAAS Activation and Cell Division

“…Nevertheless, the sample studied corresponds to only five patients bearing multiple associated co-morbidities and the results not necessarily will be the same in healthy individuals (42). The association between aldosterone plasma levels and weight and fat accumulation has also been seen in humans, where the body mass index (BMI) has been shown to have a direct correlation with plasmatic concentration of aldosterone and excretion of aldosterone in the urine (43). Weight loss in obese patients is accompanied by decreased aldosterone levels, suggesting a connection between the production/secretion of aldosterone and the adipose tissue, a condition similar to that shown in mice fed with HFD but supplemented with eplerenone.…”

Distinctive Risk Factors and Phenotype of Younger Patients With Resistant Hypertension

“…16,39 via mechanisms that include increased activity of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS). 43 Increased aldosterone levels have been associated with BMI in patients with HTN 44 and we have previously shown that BMI predicts aldosterone levels in patients with RHTN and that adiposity stimulates aldosterone release independent of renin 45 . Importantly, our data demonstrated a negative relation between BMI and PRA consistent with an adipose-related secretagogue stimulating aldosterone release.…”

“…Importantly, our data demonstrated a negative relation between BMI and PRA consistent with an adipose-related secretagogue stimulating aldosterone release. 45 …”

Prevalence and Determinants of Adult Obesity in a Low-Income Population of Western Africa: Results from a Nationwide Cross-Sectional Survey

“…In low-income populations of Western Africa, which face serious problems of malnutrition and infectious diseases including malaria, tuberculosis and HIV−AIDS, health problems related to obesity are relegated to the background. However, the World Health Organization (WHO) estimated that obesity is becoming one of the main burdens for low-and middleincome populations, because it is associated with a cluster of metabolic and cardiovascular risk factors such as hypertension, and it increases the risk of acute coronary syndromes [4,5]. Obesity is also associated with cancer and asthma, depression and osteoarthritis [6,7].…”