Relationships Among Plasma Aldosterone, High-Density Lipoprotein Cholesterol, and Insulin in Humans

Goodfriend, Theodore L.; Egan, Brent M.; Stepniakowski, K; Ball, Dennis L.

doi:10.1161/01.hyp.25.1.30

Cited by 89 publications

(70 citation statements)

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“…Moreover, similarly to Goodfriend et al, 28 we ®nd a relationship between insulin and plasma aldosterone in hypertensive patients, but the same correlation is also found in the group of severely obese but normotensive subjects. Hence it seems unlikely that high aldosterone is the link between insulin and hypertension.…”

Section: Discussionsupporting

confidence: 89%

“…27 Goodfriend et al 28 have shown a relationship between aldosterone and insulin concentrations and between plasma aldosterone concentrations and systolic blood pressure in obese subjects who were eating a high salt diet. These data have suggested insulin could have a role in hypertension in obese subjects through the reninaldosterone system.…”

Section: Discussionmentioning

confidence: 99%

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Insulin, renin-aldosterone system and blood pressure in obese people

et al. 2001

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OBJECTIVE: To evaluate the relationship between insulin, the renin-aldosterone system and blood pressure in obese subjects. DESIGN AND METHODS: A cross sectional study of a group of severely obese normotensive subjects who were surgical candidates (n 39; mean BMI: 47.8 AE 1.4) and a group of hypertensive patients (n 57; mean BMI: 28.0 AE 0.7) twenty-nine of whom had BMI b 27. All subjects were studied after 15 days on a balanced diet. Insulin, plasma renin activity and aldosterone were measured. RESULTS: Fasting insulin, plasma renin activity and aldosterone were higher in severely obese normotensive subjects than in hypertensive subjects (respectively 32.3 AE 3.0 vs 13.1 AE 1.0 mUal, P 0.0001; 1.34 AE 0.22 vs 0.88 AE 0.12 ngamlah, P 0.04; 137.2 AE 16.2 vs 87.9 AE 12.1 pgaml, P 0.015). Insulin was related to BMI and to aldosterone both in normotensive and in hypertensive patients. CONCLUSION: Hyperinsulinemia itself does not determine hypertension; in some people it could play a vasodilator role in opposition to the renin-aldosterone system.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Insulin, renin-aldosterone system and blood pressure in obese people

et al. 2001

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“…17,18 Inconsistent associations of PRA and plasma aldosterone have been described with several metabolic risk factors, including triglycerides, insulin resistance, hypertension, and low highdensity lipoprotein (HDL) cholesterol. 19,20 In a recent study in the Seychelles, populated predominantly by individuals of East African descent, PRA and plasma aldosterone were each associated with different components of the metabolic syndrome. 21 Excess production of cortisol, such as what occurs in Cushing's syndrome, results in striking similarities to the metabolic syndrome, including hypertension, insulin resistance, and dyslipidemia.…”

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confidence: 99%

Association of Adrenal Steroids With Hypertension and the Metabolic Syndrome in Blacks

et al. 2007

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Abstract-Blacks have a high prevalence of hypertension and adrenal cortical adenomas/hyperplasia. We evaluated the hypothesis that adrenal steroids are associated with hypertension and the metabolic syndrome in blacks. Ambulatory blood pressures, anthropometric measurements, and measurements of plasma renin activity (PRA), aldosterone, fasting lipids, glucose, and insulin were obtained in 397 subjects (46% hypertensive and 50% female) after discontinuing antihypertensive and lipid-lowering medications. Hypertension was defined as average ambulatory blood pressure Ͼ130/85 mm Hg. Late-night and early morning salivary cortisol, 24-hour urine-free cortisol, and cortisone excretion were measured in a consecutive subsample of 97 subjects (40% hypertensive and 52% female). Compared with normotensive subjects, hypertensive subjects had greater waist circumference and unfavorable lipid profiles, were more insulin resistant, and had lower PRA and higher plasma aldosterone and both late-night and early morning salivary cortisol concentrations. Twenty-four-hour urine-free cortisol and cortisone did not differ. Overall, ambulatory blood pressure was positively correlated with plasma aldosterone (rϭ0.22; PϽ0.0001) and late-night salivary cortisol (rϭ0.23; Pϭ0.03) and inversely correlated with PRA (rϭϪ0.21; PϽ0.001). Plasma aldosterone correlated significantly with waist circumference, total cholesterol, triglycerides, insulin, and the insulin-resistance index. Based on Adult Treatment Panel III criteria, 17% of all of the subjects were classified as having the metabolic syndrome. Plasma aldosterone levels, but not PRA, were elevated in subjects with the metabolic syndrome (Pϭ0.0002). The association of aldosterone with blood pressure, waist circumference, and insulin resistance suggests that aldosterone may contribute to obesity-related hypertension in blacks. In addition, we speculate that relatively high aldosterone and low PRA in these hypertensive individuals may reflect a mild variant of primary aldosteronism. Key Words: aldosterone Ⅲ cortisol Ⅲ hypertension Ⅲ metabolic syndrome Ⅲ insulin resistance Ⅲ plasma renin activity T he prevalence of hypertension in African-Americans is among the highest in the world. In the United States, compared with whites, hypertension is 50% more frequent in blacks. 1,2 Blacks develop hypertension at a young age and have higher rates of hypertension-related deaths and cardiovascular complications including stroke, heart disease, and end-stage renal disease. 2 In both black and white populations, hypertension is frequently associated with centripetal obesity, insulin resistance, and dyslipidemia. [3][4][5] This constellation of risk factors has been termed the metabolic syndrome and is associated with increased cardiovascular disease morbidity and mortality. 6,7 Based on an earlier study of the records of 35 000 consecutive autopsies, an increased prevalence of adrenal cortical adenomas and hyperplasia has been observed in association with essential hypertension, particularly in younger and ...

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“…Goodfriend et al 7 have suggested that aldosterone-induced hypokalemia may underlie the observed associations between increasing aldosterone levels and risk of hypertension, insulin resistance, and dyslipidemia (specifically, low HDL). With regard to insulin sensitivity, this effect would be similar to that of thiazide diuretics in that thiazide-induced hypokalemia is thought to promote glucose impairment (Figure).…”

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confidence: 99%

Aldosterone and Metabolic Dysfunction

Pimenta

Calhoun

2009

Hypertension

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A large body of evidence suggests that aldosterone excess is a common cause of hypertension with a prevalence of primary aldosteronism (PA) of Ϸ10% in patients with mildto-moderate hypertension and Ϸ20% in patients with resistant hypertension. 1 Experimental and clinical data also demonstrate that aldosterone excess contributes importantly to the development and progression of cardiorenal disease. This effect is attributed in part to aldosterone-induced target organ inflammation and fibrosis. Separately, a growing number of studies link aldosterone with the metabolic syndrome in general and with separate components of the syndrome, specifically, hypertension, insulin resistance, and dyslipidemia. If cause and effect is proven, that is, if aldosterone is confirmed to independently contribute to the development of the metabolic syndrome, it would further explain the increased cardiovascular risk of patients with PA.In this issue of Hypertension, Matrozova et al 2 compared glucose and lipid profiles in a large cohort of patients with PA to matched controls with primary hypertension. The prevalence of hyperglycemia (impaired fasting glucose or diabetes mellitus) and blood levels of glucose and lipids did not differ between PA and control subjects, whereas the prevalence of impaired fasting glucose was actually lower in PA patients. The authors further report that fasting plasma glucose and serum lipid levels did not differ within the subtypes of PA, ie, those with an aldosterone-producing adenoma versus idiopathic hyperaldosteronism. In addition, neither fasting plasma glucose or serum lipids levels improved after adrenalectomy. The authors conclude that PA is not associated with carbohydrate and lipid abnormalities and that the prevalence of metabolic syndrome does not differ significantly between patients with PA and those with primary hypertension.These results are in contrast to previous studies showing that aldosterone is associated with metabolic disturbances. In a cross-sectional study, Colussi et al 3 related plasma aldosterone levels with insulin sensitivity in 356 white patients with primary hypertension. Plasma aldosterone concentration was positively associated with plasma glucose, plasma insulin, C-peptide levels, and insulin resistance as indexed by homeostasis model assessment (HOMA). In a separate study, Mosso et al 4 compared glucose and insulin sensitivity in 30 hypertensive patients with confirmed PA and 60 matched controls. The former had higher levels of glucose and lower levels of HOMA for pancreatic ␤-cell function and C-peptide levels. A negative correlation between HOMA for pancreatic ␤-cell function and the aldosterone:renin ratio was interpreted to suggest that the decreases in insulin release were attributable to increasing aldosterone levels.Other studies have related aldosterone levels to other components of the metabolic syndrome and to risk of having the metabolic syndrome in general. In a family based study of 356 African descendents, plasma aldosterone correlated positively with wai...

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Relationships Among Plasma Aldosterone, High-Density Lipoprotein Cholesterol, and Insulin in Humans

Cited by 89 publications

References 23 publications

Insulin, renin-aldosterone system and blood pressure in obese people

Insulin, renin-aldosterone system and blood pressure in obese people

Association of Adrenal Steroids With Hypertension and the Metabolic Syndrome in Blacks

Aldosterone and Metabolic Dysfunction

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