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The Spectrum of Subclinical Primary Aldosteronism and Incident Hypertension: A Cohort Study
- Source :
- Annals of internal medicine, vol 167, iss 9
- Publication Year :
- 2017
- Publisher :
- eScholarship, University of California, 2017.
-
Abstract
- Background: Primary aldosteronism is recognized as a severe form of renin-independent aldosteronism that results in excessive mineralocorticoid receptor (MR) activation. Objective: To investigate whether a spectrum of subclinical renin-independent aldosteronism that increases risk for hypertension exists among normotensive persons. Design: Cohort study. Setting: National community-based study. Participants: 850 untreated normotensive participants in MESA (Multi-Ethnic Study of Atherosclerosis) with measurements of serum aldosterone and plasma renin activity (PRA). Measurements: Longitudinal analyses investigated whether aldosterone concentrations, in the context of physiologic PRA phenotypes (suppressed, ≤0.50 µg/L per hour; indeterminate, 0.51 to 0.99 µg/L per hour; unsuppressed, ≥1.0 µg/L per hour), were associated with incident hypertension (defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or initiation of antihypertensive medications). Cross-sectional analyses investigated associations between aldosterone and MR activity, assessed via serum potassium and urinary fractional excretion of potassium. Results: A suppressed renin phenotype was associated with a higher rate of incident hypertension than other PRA phenotypes (incidence rates per 1000 person-years of follow-up: suppressed renin phenotype, 85.4 events [95% CI, 73.4 to 99.3 events]; indeterminate renin phenotype, 53.3 events [CI, 42.8 to 66.4 events]; unsuppressed renin phenotype, 54.5 events [CI, 41.8 to 71.0 events]). With renin suppression, higher aldosterone concentrations were independently associated with an increased risk for incident hypertension, whereas no association between aldosterone and hypertension was seen when renin was not suppressed. Higher aldosterone concentrations were associated with lower serum potassium and higher urinary excretion of potassium, but only when renin was suppressed. Limitation: Sodium and potassium were measured several years before renin and aldosterone. Conclusion: Suppression of renin and higher aldosterone concentrations in the context of this renin suppression are associated with an increased risk for hypertension and possibly also with increased MR activity. These findings suggest a clinically relevant spectrum of subclinical primary aldosteronism (renin-independent aldosteronism) in normotension. Primary Funding Source: National Institutes of Health.
- Subjects :
- Male
medicine.medical_specialty
Urinary system
030209 endocrinology & metabolism
030204 cardiovascular system & hematology
Cardiovascular
Plasma renin activity
Medical and Health Sciences
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Mineralocorticoid receptor
Primary aldosteronism
Risk Factors
Clinical Research
Internal medicine
General & Internal Medicine
Renin–angiotensin system
Hyperaldosteronism
Renin
Receptors
Internal Medicine
80 and over
Genetics
Medicine
Humans
2.1 Biological and endogenous factors
Longitudinal Studies
Aetiology
Aldosterone
Aged
business.industry
Incidence
General Medicine
Middle Aged
medicine.disease
Blood pressure
Endocrinology
Cross-Sectional Studies
chemistry
Mineralocorticoid
Hypertension
Potassium
Female
business
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Annals of internal medicine, vol 167, iss 9
- Accession number :
- edsair.doi.dedup.....89594c2de916fe946ffd1e708381e21b