Bimodal aldosterone distribution in low-renin hypertension.

Abstract

BACKGROUND:

In low-renin hypertension (LRH), serum aldosterone levels are higher in those subjects with primary aldosteronism and may be lower in those with non-aldosterone mineralocorticoid excess or primary renal sodium retention. We investigated the hypothesis that the frequency distribution of aldosterone in LRH is bimodal.

METHODS:

Of the 3,532 attendees at the sixth examination cycle of the Framingham Offspring Study, 1,831 were included in this cross-sectional analysis after we excluded those with conditions or taking medications such as antihypertensive drugs that might affect renin or aldosterone.

RESULTS:

Three hundred three subjects (17%) had untreated hypertension (SBP ≥140 mm Hg or DBP ≥90 mm Hg). LRH, defined as plasma renin ≤5 mU/L, was present in 93 of those 303 hypertensive subjects (31%). Aldosterone values were adjusted statistically for age, sex, and the urinary sodium/creatinine ratio. In the subjects with LRH, the adjusted aldosterone distribution was bimodal (dip test for unimodality, P = 0.008). The adjusted aldosterone distribution was unimodal in the normal subjects (P = 0.98) and in the hypertensive subjects with normal plasma renin (P = 0.94).

CONCLUSIONS:

In this community-based sample of white subjects, those with low-renin hypertension had a bimodal adjusted aldosterone distribution. Subjects with normal-renin hypertension and subjects with normal blood pressure had unimodal adjusted aldosterone distributions. These findings suggest 2 pathophysiological variants of LRH, one that is aldosterone-dependent and one that is non-aldosterone-dependent.

• Authors: E Victor Adlin, Leonard E Braitman, Ramachandran S Vasan
• Journal: American journal of hypertension (Am J Hypertens) Vol. 26 Issue 9 Pg. 1076-85 (Sep 2013) ISSN: 1941-7225 [Electronic] United States
• PMID: 23757402 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Aldosterone
• Renin

Topics

• Aged
• Aldosterone (blood)
• Cross-Sectional Studies
• Female
• Humans
• Hyperaldosteronism (blood)
• Hypertension (blood)
• Male
• Middle Aged
• Renin (blood)