Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study
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. ABP and ABP monitoring phenotypes were assessed in 912 Jackson Heart St...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2021-06, Vol.143 (24), p.2355-2366 |
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| creator | Joseph, Joshua J. Pohlman, Neal K. Zhao, Songzhu Kline, David Brock, Guy Echouffo-Tcheugui, Justin B. Sims, Mario Effoe, Valery S. Wu, Wen-Chih Kalyani, Rita R. Wand, Gary S. Kluwe, Bjorn Hsueh, Willa A. Abdalla, Marwah Shimbo, Daichi Golden, Sherita H. |
| description | 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.
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.
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 |
| doi_str_mv | 10.1161/CIRCULATIONAHA.120.050896 |
| format | Article |
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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.
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
<0.05). A higher log-aldosterone was associated with higher clinic, awake, and asleep DBP (all
<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.
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.</description><identifier>ISSN: 0009-7322</identifier><identifier>ISSN: 1524-4539</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.120.050896</identifier><identifier>PMID: 33605160</identifier><language>eng</language><publisher>United States: by the American College of Cardiology Foundation and the American Heart Association, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Aldosterone - blood ; Black or African American ; Blood Pressure - physiology ; Female ; Humans ; Hypertension - pathology ; Logistic Models ; Longitudinal Studies ; Male ; Middle Aged ; Odds Ratio ; Phenotype ; Prospective Studies ; Renin - blood ; Renin-Angiotensin System ; Time Factors ; Young Adult</subject><ispartof>Circulation (New York, N.Y.), 2021-06, Vol.143 (24), p.2355-2366</ispartof><rights>by the American College of Cardiology Foundation and the American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4688-2b88864850fb87137c398f22e272c62ccd9fdfbe223b39b482023f6250e655d3</citedby><cites>FETCH-LOGICAL-c4688-2b88864850fb87137c398f22e272c62ccd9fdfbe223b39b482023f6250e655d3</cites><orcidid>0000-0001-9169-8261 ; 0000-0001-5317-079X ; 0000-0002-2725-505X ; 0000-0002-8460-1617 ; 0000-0002-2834-2024 ; 0000-0001-6302-8834</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33605160$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Joseph, Joshua J.</creatorcontrib><creatorcontrib>Pohlman, Neal K.</creatorcontrib><creatorcontrib>Zhao, Songzhu</creatorcontrib><creatorcontrib>Kline, David</creatorcontrib><creatorcontrib>Brock, Guy</creatorcontrib><creatorcontrib>Echouffo-Tcheugui, Justin B.</creatorcontrib><creatorcontrib>Sims, Mario</creatorcontrib><creatorcontrib>Effoe, Valery S.</creatorcontrib><creatorcontrib>Wu, Wen-Chih</creatorcontrib><creatorcontrib>Kalyani, Rita R.</creatorcontrib><creatorcontrib>Wand, Gary S.</creatorcontrib><creatorcontrib>Kluwe, Bjorn</creatorcontrib><creatorcontrib>Hsueh, Willa A.</creatorcontrib><creatorcontrib>Abdalla, Marwah</creatorcontrib><creatorcontrib>Shimbo, Daichi</creatorcontrib><creatorcontrib>Golden, Sherita H.</creatorcontrib><title>Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>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.
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.
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
<0.05). A higher log-aldosterone was associated with higher clinic, awake, and asleep DBP (all
<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.
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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aldosterone - blood</subject><subject>Black or African American</subject><subject>Blood Pressure - physiology</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension - pathology</subject><subject>Logistic Models</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Odds Ratio</subject><subject>Phenotype</subject><subject>Prospective Studies</subject><subject>Renin - blood</subject><subject>Renin-Angiotensin System</subject><subject>Time Factors</subject><subject>Young Adult</subject><issn>0009-7322</issn><issn>1524-4539</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkctu1DAUhiMEoqXwCsjs2GTwJXYcFkhhBMygEUXtIJaW45wwpk5cbKfVPAGvjYcpFV0dX77zH1tfUbwieEGIIG-W64vlt027XZ9_aVftglC8wBzLRjwqTgmnVVlx1jwuTjHGTVkzSk-KZzH-zFvBav60OGFMYE4EPi1-tzF6Y3WyfkJ-QJcQ5hG1rvcxQfATID316KvTcdToAiY7odYke2PTHn23aYfasZudTj7s0XvnfWYDxDgHQAd0CNboXEf4u4hv0XYH6LM2VzHPW4EOCV2mud8_L54M2kV4cVfPiu3HD9vlqtycf1ov201pKiFlSTsppagkx0Mna8Jqwxo5UAq0pkZQY_pm6IcOKGUda7pKUkzZICjHIDjv2Vnx7hh7PXcj9AamFLRT18GOOuyV11Y9vJnsTv3wN0rWsmFVlQNe3wUE_2uGmNRoowHn9AR-jopWDWk4o4RktDmiJvgYAwz3YwhWB4_qoUeVPaqjx9z78v933nf-E5eB6gjcepdFxSs330JQO9Au7VQ2jRkmdZm_T7AgHJeHI8n-AHuxrHk</recordid><startdate>20210615</startdate><enddate>20210615</enddate><creator>Joseph, Joshua J.</creator><creator>Pohlman, Neal K.</creator><creator>Zhao, Songzhu</creator><creator>Kline, David</creator><creator>Brock, Guy</creator><creator>Echouffo-Tcheugui, Justin B.</creator><creator>Sims, Mario</creator><creator>Effoe, Valery S.</creator><creator>Wu, Wen-Chih</creator><creator>Kalyani, Rita R.</creator><creator>Wand, Gary S.</creator><creator>Kluwe, Bjorn</creator><creator>Hsueh, Willa A.</creator><creator>Abdalla, Marwah</creator><creator>Shimbo, Daichi</creator><creator>Golden, Sherita H.</creator><general>by the American College of Cardiology Foundation and the American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-9169-8261</orcidid><orcidid>https://orcid.org/0000-0001-5317-079X</orcidid><orcidid>https://orcid.org/0000-0002-2725-505X</orcidid><orcidid>https://orcid.org/0000-0002-8460-1617</orcidid><orcidid>https://orcid.org/0000-0002-2834-2024</orcidid><orcidid>https://orcid.org/0000-0001-6302-8834</orcidid></search><sort><creationdate>20210615</creationdate><title>Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study</title><author>Joseph, Joshua J. ; Pohlman, Neal K. ; Zhao, Songzhu ; Kline, David ; Brock, Guy ; Echouffo-Tcheugui, Justin B. ; Sims, Mario ; Effoe, Valery S. ; Wu, Wen-Chih ; Kalyani, Rita R. ; Wand, Gary S. ; Kluwe, Bjorn ; Hsueh, Willa A. ; Abdalla, Marwah ; Shimbo, Daichi ; Golden, Sherita H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4688-2b88864850fb87137c398f22e272c62ccd9fdfbe223b39b482023f6250e655d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aldosterone - blood</topic><topic>Black or African American</topic><topic>Blood Pressure - physiology</topic><topic>Female</topic><topic>Humans</topic><topic>Hypertension - pathology</topic><topic>Logistic Models</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Odds Ratio</topic><topic>Phenotype</topic><topic>Prospective Studies</topic><topic>Renin - blood</topic><topic>Renin-Angiotensin System</topic><topic>Time Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Joseph, Joshua J.</creatorcontrib><creatorcontrib>Pohlman, Neal K.</creatorcontrib><creatorcontrib>Zhao, Songzhu</creatorcontrib><creatorcontrib>Kline, David</creatorcontrib><creatorcontrib>Brock, Guy</creatorcontrib><creatorcontrib>Echouffo-Tcheugui, Justin B.</creatorcontrib><creatorcontrib>Sims, Mario</creatorcontrib><creatorcontrib>Effoe, Valery S.</creatorcontrib><creatorcontrib>Wu, Wen-Chih</creatorcontrib><creatorcontrib>Kalyani, Rita R.</creatorcontrib><creatorcontrib>Wand, Gary S.</creatorcontrib><creatorcontrib>Kluwe, Bjorn</creatorcontrib><creatorcontrib>Hsueh, Willa A.</creatorcontrib><creatorcontrib>Abdalla, Marwah</creatorcontrib><creatorcontrib>Shimbo, Daichi</creatorcontrib><creatorcontrib>Golden, Sherita H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Joseph, Joshua J.</au><au>Pohlman, Neal K.</au><au>Zhao, Songzhu</au><au>Kline, David</au><au>Brock, Guy</au><au>Echouffo-Tcheugui, Justin B.</au><au>Sims, Mario</au><au>Effoe, Valery S.</au><au>Wu, Wen-Chih</au><au>Kalyani, Rita R.</au><au>Wand, Gary S.</au><au>Kluwe, Bjorn</au><au>Hsueh, Willa A.</au><au>Abdalla, Marwah</au><au>Shimbo, Daichi</au><au>Golden, Sherita H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2021-06-15</date><risdate>2021</risdate><volume>143</volume><issue>24</issue><spage>2355</spage><epage>2366</epage><pages>2355-2366</pages><issn>0009-7322</issn><issn>1524-4539</issn><eissn>1524-4539</eissn><abstract>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.
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.
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
<0.05). A higher log-aldosterone was associated with higher clinic, awake, and asleep DBP (all
<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.
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.</abstract><cop>United States</cop><pub>by the American College of Cardiology Foundation and the American Heart Association, Inc</pub><pmid>33605160</pmid><doi>10.1161/CIRCULATIONAHA.120.050896</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-9169-8261</orcidid><orcidid>https://orcid.org/0000-0001-5317-079X</orcidid><orcidid>https://orcid.org/0000-0002-2725-505X</orcidid><orcidid>https://orcid.org/0000-0002-8460-1617</orcidid><orcidid>https://orcid.org/0000-0002-2834-2024</orcidid><orcidid>https://orcid.org/0000-0001-6302-8834</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0009-7322 |
| ispartof | Circulation (New York, N.Y.), 2021-06, Vol.143 (24), p.2355-2366 |
| issn | 0009-7322 1524-4539 1524-4539 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8789344 |
| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | Adult Aged Aged, 80 and over Aldosterone - blood Black or African American Blood Pressure - physiology Female Humans Hypertension - pathology Logistic Models Longitudinal Studies Male Middle Aged Odds Ratio Phenotype Prospective Studies Renin - blood Renin-Angiotensin System Time Factors Young Adult |
| title | Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study |
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