Context: Body mass index (BMI) shows a direct correlation with plasma aldosterone concentration (PAC) and urinary aldosterone excretion in normotensive individuals; whether the same applies to hypertensive patients is unknown. Objective: Our objective was to determine if BMI predicts PAC and the PAC/plasma renin activity ratio [aldosterone renin ratio (ARR)] in hypertensive patients, and if this affects the identification of primary aldosteronism (PA). Design: This was a prospective evaluation of consecutive hypertensive patients referred nationwide to specialized hypertension centers. Main Outcome Measures: Sitting PAC, plasma renin activity, and the ARR, baseline and after 50 mg captopril orally with concomitant assessment of parameters, including BMI and daily sodium intake, were calculated. Results: Complete biochemical data and a definite diagnosis were obtained in 1125 consecutive patients. Of them 999 had primary (essential) hypertension (PH) and 126 (11.2%) PA caused by an aldosterone-producing adenoma in 54 (4.8%). BMI independently predicted PAC (β = 0.153; P < 0.0001) in PH, particularly in the overweight-obese, but not in the PA group. Covariance analysis and formal comparison of the raw, and the BMI-, sex-, and sodium intake-adjusted ARR with receiver operator characteristic curves, showed no significant improvement for the discrimination of aldosterone-producing adenoma from PH patients with covariate-adjusted ARR. Conclusions: BMI correlated with PAC independent of age, sex, and sodium intake in PH, but not in PA patients. This association of BMI is particularly evident in overweight-obese PH patients, and suggests a pathophysiological link between visceral adiposity and aldosterone secretion. However, it does not impact on the diagnostic accuracy of the ARR for discriminating PA from PH patients.
|Autori:||ROSSI GP; BELFIORE A; BERNINI G; DESIDERI G; FABRIS B; CARIDI G; FERRI C; GIACCHETTI G; LETIZIA C; MACCARIO M; MANNELLI M; PALUMBO G; PATALANO A; RIZZONI D; ROSSI E; PESSINA AC; MANTERO F; FOR THE PAPY STUDY INVESTIGATORS|
|Titolo:||Body Mass Index Predicts Plasma Aldosterone Concentrations in Overweight-Obese Primary Hypertensive Patients|
|Anno del prodotto:||2008|
|Digital Object Identifier (DOI):||10.1210/jc.2008-0251|
|Appare nelle tipologie:||1.1 Articolo in rivista|