title: Body Mass Index Predicts 24-Hour Urinary Aldosterone Levels in Patients With Resistant Hypertension.
abstract: Prospective studies indicate that hyperaldosteronism is found in 20% of patients with resistant hypertension. A small number of observational studies in normotensive and hypertensive patients suggest a correlation between aldosterone levels and obesity while others could not confirm these findings. The correlation between aldosterone levels and body mass index (BMI) in patients with resistant hypertension has not been previously investigated. Our objective was to determine whether BMI is positively correlated with plasma aldosterone concentration, plasma renin activity, aldosterone:renin ratio, and 24-hour urinary aldosterone in black and white patients. We performed a cross-sectional analysis of a large diverse cohort (n=2170) with resistant hypertension. The relationship between plasma aldosterone concentration, plasma renin activity, aldosterone:renin ratio, 24-hour urinary aldosterone, and BMI was investigated for the entire cohort, by sex and race (65.3% white, 40.3% men). We demonstrate that plasma aldosterone concentration and aldosterone:renin ratio were significantly correlated to BMI (P<0.0001) across the first 3 quartiles, but not from the 3rd to 4th quartile of BMI. Plasma renin activity was not correlated with BMI. Twenty-four-hour urinary aldosterone was positively correlated across all quartiles of BMI for the cohort (P<0.0001) and when analyzed by sex (men P<0.0001; women P=0.0013) and race (P<0.05), and stronger for men compared with women (r=0.19, P<0.001 versus r=0.05, P=0.431, P=0.028) regardless of race. In both black and white patients, aldosterone levels were positively correlated to increasing BMI, with the correlation being more pronounced in black and white men. These findings suggest that obesity, particularly the abdominal obesity typical of men, contributes to excess aldosterone in patients with resistant hypertension.
authors.affiliation: From the Division of Cardiovascular Disease, Vascular Biology, and Hypertension Program (T.D., L.G., M.L., S.O., D.A.C.), School of Medicine (M.L.), and Department of Biostatistics, School of Public Health (P.L.), University of Alabama at Birmingham. tduden@uab.edu.
authors.forename: Tanja
authors.initials: T
authors.lastname: Dudenbostel
authors.affiliation: From the Division of Cardiovascular Disease, Vascular Biology, and Hypertension Program (T.D., L.G., M.L., S.O., D.A.C.), School of Medicine (M.L.), and Department of Biostatistics, School of Public Health (P.L.), University of Alabama at Birmingham.
authors.forename: Lama
authors.initials: L
authors.lastname: Ghazi
authors.affiliation: From the Division of Cardiovascular Disease, Vascular Biology, and Hypertension Program (T.D., L.G., M.L., S.O., D.A.C.), School of Medicine (M.L.), and Department of Biostatistics, School of Public Health (P.L.), University of Alabama at Birmingham.
authors.forename: Mingchun
authors.initials: M
authors.lastname: Liu
authors.affiliation: From the Division of Cardiovascular Disease, Vascular Biology, and Hypertension Program (T.D., L.G., M.L., S.O., D.A.C.), School of Medicine (M.L.), and Department of Biostatistics, School of Public Health (P.L.), University of Alabama at Birmingham.
authors.forename: Peng
authors.initials: P
authors.lastname: Li
authors.affiliation: From the Division of Cardiovascular Disease, Vascular Biology, and Hypertension Program (T.D., L.G., M.L., S.O., D.A.C.), School of Medicine (M.L.), and Department of Biostatistics, School of Public Health (P.L.), University of Alabama at Birmingham.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.affiliation: From the Division of Cardiovascular Disease, Vascular Biology, and Hypertension Program (T.D., L.G., M.L., S.O., D.A.C.), School of Medicine (M.L.), and Department of Biostatistics, School of Public Health (P.L.), University of Alabama at Birmingham.
authors.forename: David A
authors.initials: DA
authors.lastname: Calhoun
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000450:Aldosterone / Q000652:urine; D001795:Blood Pressure Determination; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000453:epidemiology* / Q000503:physiopathology / Q000652:urine*; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology / Q000652:urine*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D044469:Racial Groups; D012084:Renin-Angiotensin System / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D000450:Aldosterone
keywords: association; body mass index; body weight; hypertension; obesity