Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study.
Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study.
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DOI：
10.1161/circulationaha.120.050896
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发表时间：
2021-06-15
期刊：
影响因子：
37.8
通讯作者：
Golden SH
中科院分区：
文献类型：
--
作者：
Joseph JJ;Pohlman NK;Zhao S;Kline D;Brock G;Echouffo-Tcheugui JB;Sims M;Effoe VS;Wu WC;Kalyani RR;Wand GS;Kluwe B;Hsueh WA;Abdalla M;Shimbo D;Golden SH
肾素-血管紧张素-醛固酮系统（RAAS）是血压的重要驱动因素，但尚未评估非裔美国人（AA）中RAAS与动态血压（ABP）和ABPM表型的相关性。对912例杰克逊心脏研究参与者的ABP和ABPM表型进行了评估，包括醛固酮和血浆肾素活性（PRA）。采用多变量线性和logistic回归分析醛固酮和PRA与门诊、清醒和睡眠时收缩压（SBP）、舒张压（DBP）和ABPM表型的相关性，校正重要混杂因素。参与者的平均年龄为59 ±11岁，69%为女性。在完全校正的模型中，较低的log-PRA与较高的门诊、清醒和睡眠SBP和DBP相关（所有p<0.05）。较高的对数醛固酮与较高的临床、清醒和睡眠DBP相关（所有p<0.05）。log-PRA高1个单位与白天高血压的几率低相关（OR：0.59，95%CI：0.49，0.71），夜间高血压（OR：0.68，95%CI：0.58，0.79），白天和夜间高血压（OR：0.59，95%CI：0.48，0.71）、持续性高血压（OR：0.52，95%CI：0.39，0.70）和隐匿性高血压（OR 0.75，95%CI：0.62，0.90）。高1个单位的对数醛固酮与夜间高血压的几率较高相关（OR：1.38，95%CI：1.05，1.81）。PRA和醛固酮均与百分比下降、非下降BP模式或白大衣高血压无关。醛固酮：肾素比值的模式与PRA相似。ABPM显示，在诊室、清醒和睡眠期间，抑制的肾素活性和较高的醛固酮：肾素比值与较高的SBP和DBP相关。在门诊、清醒和睡眠期间，较高的醛固酮水平与较高的DBP相关，但与SBP无关。针对低肾素生理学的新型和获批药物（如上皮钠通道抑制剂和盐皮质激素受体拮抗剂）的进一步临床研究可能对改善AA患者的高血压控制至关重要。
The renin-angiotensin-aldosterone system (RAAS) is an important driver of BP but the association of the RAAS with ambulatory blood pressure (ABP) and ABPM phenotypes among African Americans (AA) has not been assessed. ABP and ABPM phenotypes were assessed in 912 Jackson Heart Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analysis were used to analyze the association of aldosterone, and PRA with clinic, awake and asleep systolic blood pressure (SBP) and diastolic blood pressure (DBP) and ABPM 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 SBP 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 (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 were associated with percent dipping, non-dipping BP pattern, or white-coat hypertension. Patterns for aldosterone:renin ratio were similar to PRA. Suppressed renin activity and higher aldosterone:renin ratios were associated with both higher SBP and DBP in the office and during the awake and asleep periods as evidenced by ABPM. Higher aldosterone levels were associated with higher DBP, but not SBP, 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 AAs.