Aldosterone levels, aortic stiffness, and wave reflection in essential hypertensive patients

BACKGROUND The aim of the present study was to evaluate the grade of arterial stiffening, in relation to aldosterone (ALDO) and plasma renin activity (PRA) levels, in essential never-treated hypertensive patients. MATERIALS AND METHODS We studied 1,330 consecutive patients without clinical and/or laboratory findings of primary or secondary aldosteronism. Arterial stiffness indices Aix75 and carotid-femoral pulse wave velocity (PWVc-f) were measured and a 24-hour urine collection for ALDO was carried out to classify patients with low ALDO <12 mcg/24 hours and high ALDO >12 but <24 mcg/24 hours. Patients were divided according to PRA (high PRA > 1ng/ml/hour, low PRA < 1ng/ml/hour) and ALDO levels (high ALDO > 12 but <24 mcg/24 hours, low ALDO < 12 mcg/24 hours) in four groups. Also patients were grouped according to serum ALDO quartiles, 24-hour urine ALDO quartiles, PRA quartiles, and serum ALDO/PRA quartiles. RESULTS Patients were classified in 4 groups: group I (high ALDO and low PRA), group II (high ALDO and high PRA), group III (low ALDO and low PRA), and finally group IV (low ALDO and high PRA). PWVc-f and AoAIx75 were significantly higher in group I followed by group II, III, and IV (P < 0.001). Comparison of arterial stiffness indices according to PRA quartiles and PWVc-f and AoAIx75 showed significantly higher in the 1st quartile compared to 2nd, 3rd, and 4th, respectively (P < 0.001). PWVc-f and AoAIx75 were also compared among the four quartiles of aldosterone-renin ratio and they were significantly higher (P < 0.001) in the 4th quartile followed by the 3rd, 2nd, and 1st, respectively. CONCLUSIONS Arterial stiffness indices are higher among essential hypertensive patients with high normal serum and urine ALDO levels, pointing to a causal relationship between renin-angiotensin-aldosterone system activation and large artery properties. © 2014 American Journal of Hypertension, Ltd. All rights reserved

Aldosterone levels and inflammatory stimulation in essential hypertensive patients

Recent studies indicate that the pro-inflammatory action of aldosterone (ALDO) or the activation of mineralocorticoid receptors contribute to the increased risk of cardiovascular disease (CVD). The aim of the present study was to investigate the grade of the inflammatory activation, in relation to ALDO levels, in a large cohort of essential hypertensive patients. The study included 3770 consecutive essential hypertensive patients who attended our outpatient clinics. Patients were evaluated with medical history, repeated office blood pressure and 24-h ambulatory blood pressure monitoring (ABPM), physical examination and full laboratory assessment including ALDO in 24-h urine collection, plasma renin activity (PRA), high-sensitivity C-reactive protein (hsCRP), total fibrinogen, serum homocysteine (Hcy), serum amyloid A (SAA) and white blood cells (WBC) measurements in morning blood samples. Patients were divided according to PRA (high PRA >1 ng ml -1 h -1, low PRA <1 ng ml -1 h -1) and ALDO levels (high ALDO >12 but <24 μg per 24 h, low ALDO <12 μg per 24 h) in four groups. The hsCRP (P<0.022) and SAA (P<0.001) levels increased in parallel with the ALDO metabolism. Similar differences were observed for Hcy (P<0.001), fibrinogen (P=0.001) and WBC (P<0.02). High ALDO levels within normal range are related to the presence of subclinical inflammation in essential hypertension. These data indicate that ALDO and PRA influence the process of subclinical inflammation involved in the increased risk of CVD.© 2013 Macmillan Publishers Limited All rights reserved

Serum phosphate in white-coat hypertensive patients: Focus on dipping status and metabolic syndrome

Recent studies indicate an association between serum phosphate levels and blood pressure in hypertensive patients. A growing body of evidence suggests that white-coat hypertension (WCH) is associated with target organ damage. Furthermore, metabolic syndrome (MS) and a non-dipping pattern are associated with increased cardiovascular risk. The purpose of this study was to explore the nocturnal blood pressure fall in patients with WCH according to their serum phosphate levels and number of MS components fulfilled. The study included 2600 patients with WCH who attended our outpatient clinics. All patients underwent repeated office blood pressure measurements, 24-h ambulatory blood pressure monitoring and full clinical and laboratory evaluation. The diagnosis of MS was made according to the Adult Treatment Panel III criteria. Dipping pattern was defined as follows: dippers had a nocturnal systolic blood pressure (NSBP) fall 10% but 20%; non-dippers had an NSBP fall 10%; extreme dippers had an NSBP fall 20% and reverse dippers had an NSBP increase. There were 314 extreme dippers, 1337 dippers, 734 non-dippers and 116 reverse dippers. Reverse dippers presented with significantly lower levels of serum phosphate, whereas extreme dippers had significantly higher levels (3.39±3.29 vs. 3.58±3.52 mg per 100 ml, P<0.0001). The patients were classified according to the number of MS components and the main observation was the inverse relationship of serum phosphate with MS components (3.53±0.36, 3.50±0.38, 3.49±0.38, 3.44±0.36 and 3.35±0.31 mg per 100 ml, respectively, P<0.003). Patients with WCH and low serum phosphate levels appear to have a higher incidence of a non-dipping NSBP profile and an impaired metabolic profile. This observation may be important for the stratification of the cardiovascular risk in WCH patients. © 2010 The Japanese Society of Hypertension All rights reserved

Ambulatory blood pressure profile in hypertensive patients with Β-thalassemia minor

Β-thalassemia trait (Β-TT) is a common genetic disorder in Mediterranean countries, including Greece. Previous studies have shown the protective effect of Β-TT against myocardial infarction. However, the ambulatory blood pressure (BP) profile of such patients has not yet been investigated. Thus, the purpose of the present study was to investigate the ambulatory BP monitoring (ABPM) profile of hypertensives with Β-TT, in comparison with all-cause anemic and non-anemic essential hypertensive patients. The study ultimately comprised of 8861 essential hypertensive, nondiabetic patients who were divided into three groups: group I (n191, with Β-TT), group II (n655, anemic) and group III (n8015, nonanemic). All patients underwent full clinical, laboratory and echocardiographic evaluations, whereas all were subjected to ABPM. Anemia was defined as Hb 12 <g per 100 ml for women and <13 g per 100 ml for men, whereas patients with Β-TT were self-referred. The distribution of dipping patterns among the three groups was 61.3 vs. 41.2 vs. 45.8% (P<0.001), whereas for nondippers it was 20.4 vs. 31.5 vs. 27.7% (P<0.001), for extreme-dippers it was 15.7 vs. 15.0 vs. 17.5% (P<0.001) and for reverse dippers it was 2.6 vs. 12.4 vs. 9.0% (P<0.001). Furthermore, mean daytime systolic BP (SBP) among the three groups was 140.13±7.79 vs. 142.021±1.61 vs. 141.99±9.87 mm Hg (P<0.03), and mean nighttime SBP was 125.871±0.4 vs. 131.1315.7 vs. 129.621±3.31 mm Hg (P<0.001). In the multiple regression analysis, after adjustments for age, body mass index and lipid levels, the differences among daytime and nighttime SBP remained significant at 140.18±9.84 vs. 142.02±9.85 vs. 141.99±9.85 mm Hg (P<0.04) and 125.991±3.07 vs. 131.191±3.08 vs. 129.611±3.07 mm Hg (P<0.001), respectively. Hypertensive patients with Β-TT present with a better 24-h BP profile in comparison with anemic and nonanemic hypertensives. Thus, Β-TT may function protectively in their total cardiovascular risk profile. © 2011 The Japanese Society of Hypertension All rights reserved