Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study

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.

Keywords: African Americans; aldosterone; blood pressure monitoring, ambulatory; hypertension; longitudinal studies.

Figure 1.

The Association of Log-Aldosterone, Log-Plasma Renin Activity and Log-Aldosterone: Renin Ratio with Clinic, Daytime, and Nighttime Systolic Blood Pressure, Diastolic Blood Pressure and Percent Dipping Model adjusted for age, sex, education and occupation, smoking, waist circumference, physical activity, low-density lipoprotein, history of cardiovascular disease, alcohol, diabetes, hormone replacement therapy, estimated glomerular filtration rate, and PRA or aldosterone (Table V in the Supplement, Model 2) * indicates log-transformed variable Abbreviations: SBP = systolic blood pressure; DBP = diastolic blood pressure, PRA = plasma renin activity; ARR = aldosterone: renin ratio. Beta to mmHg Conversion: Beta*ln(2)

Figure 2.

The Association of Log-Aldosterone, Log-Plasma Renin Activity and Log-Aldosterone: Renin Ratio with Ambulatory Blood Pressure Phenotypes Model adjusted for age, sex, education and occupation, smoking, waist circumference, physical activity, low-density lipoprotein, history of cardiovascular disease, alcohol, diabetes, hormone replacement therapy, estimated glomerular filtration rate, and PRA or aldosterone (Table VI in the Supplement, Model 2) * indicates log-transformed variable Abbreviations: HTN = hypertension; PRA = plasma renin activity; ARR = aldosterone: renin ratio Clinic Hypertension = clinic SBP ≥140 mmHg or clinic DBP ≥90 mmHg; Daytime Hypertension = daytime SBP ≥ 135 mmHg or daytime DBP ≥85 mmHg, Nocturnal Hypertension = night-time SBP ≥ 120 mmHg or night-time DBP ≥ 70 mmHg; Daytime & Nocturnal hypertension = combination of Daytime and Nocturnal Hypertension; Sustained hypertension = combination of Clinic and Daytime Hypertension; Non-Dipping Pattern = <10% decrease in mean awake vs mean asleep SBP; White Coat Hypertension = absence of Daytime Hypertension with presence of Clinic Hypertension, Masked Hypertension = presence of Daytime Hypertension with absence of Clinic Hypertension.

Figure 3:

The Association of Plasma Renin Activity Phenotypes with Clinic, Daytime, and Nighttime Systolic Blood Pressure, Diastolic Blood Pressure and Percent Dipping Model adjusted for age, sex, education and occupation, smoking, waist circumference, physical activity, low-density lipoprotein, history of cardiovascular disease, alcohol, diabetes, hormone replacement therapy, estimated glomerular filtration rate, and aldosterone (Table X in the Supplement, Model 1) Suppressed Renin Phenotype is defined as plasma renin activity ≤ 0.50 ng/ml/hr; Indeterminate Renin Phenotype is defined as plasma renin activity between 0.51 and 0.99 ng/ml/hr; Unsuppressed Renin Phenotype is defined as plasma renin activity ≥1.0 ng/ml/hr. Abbreviations: SBP = systolic blood pressure; DBP = diastolic blood pressure; PRA = plasma renin activity

Figure 4:

The Association of Plasma Renin Activity Phenotypes with Ambulatory Blood Pressure Phenotypes Model adjusted for age, sex, education and occupation, smoking, waist circumference, physical activity, low-density lipoprotein, history of cardiovascular disease, alcohol, diabetes, hormone replacement therapy, estimated glomerular filtration rate, and aldosterone (Table XI in the Supplement, Model 1) Suppressed Renin Phenotype is defined as plasma renin activity ≤ 0.50 ng/ml/hr; Indeterminate Renin Phenotype is defined as plasma renin activity between 0.51 and 0.99 ng/ml/hr; Unsuppressed Renin Phenotype is defined as plasma renin activity ≥1.0 ng/ml/hr. Abbreviations: HTN = hypertension; PRA = plasma renin activity Clinic Hypertension = clinic SBP ≥140 mmHg or clinic DBP ≥90 mmHg; Daytime Hypertension = daytime SBP ≥ 135 mmHg or daytime DBP ≥85 mmHg, Nocturnal Hypertension = night-time SBP ≥ 120 mmHg or night-time DBP ≥ 70 mmHg; Daytime & Nocturnal hypertension = combination of Daytime and Nocturnal Hypertension; Sustained hypertension = combination of Clinic and Daytime Hypertension; Non-Dipping Pattern = <10% decrease in mean awake vs mean asleep SBP; White Coat Hypertension = absence of Daytime Hypertension with presence of Clinic Hypertension, Masked Hypertension = presence of Daytime Hypertension with absence of Clinic Hypertension.