The state of renin-aldosterone system in patients with resistant arterial hypertension

Authors

  • О. H. Оbertynska National Pirogov Memorial Medical University, Vinnytsia, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2019.3.168951

Keywords:

hypertension, active renin, aldosterone

Abstract

Purpose. The understanding of pathophysiology and clinical characteristics of resistant hypertension (RH) remains elusive. The aim of this work was to study the relationships between clinical course of RH and levels of renin and aldosterone (AS).

Materials and methods. A total of 47 patients with true RH were included in the study. The control group included 50 patients with controlled arterial hypertension (CAH). All patients underwent general clinical examination, calculation of body mass index (BMI), office blood pressure measurement, determination of plasma potassium, AS and active renin concentrations (ARC), assessment of plasma aldosterone-to-renin ratio, urinary albumin excretion, albumin-creatinine ratio (ACR), uric acid, serum creatinine, calculation of glomerular filtration rate (GFR) by Cockcroft–Gault formula, echocardiography.

Results. AS and ARC levels were significantly higher (AS 145.21 ± 11.90 ng/ml and 122.04 ± 8.60 ng/ml, P < 0.001; ARC 18.21 ± 3.50 ng/ml and 14.40 ± 2.20 ng/ml, P < 0.05) in patients with RH compared to those with CAH, respectively. At the same time, among patients with RH, only 38 % had a normal ARC; increased ARC was in 27 % and reduced ARC was in 35 % of patients. Among patients with CAH, 78 % had a normal ARC; increased ARC was in 7 % and reduced ARC was in 15 % of patients.

In patients with CAH, there was negative correlation between AS and ARC levels (r = -0.38, P < 0.05), at the same time in patients with RH, no correlation was found between AS and ARC levels. However, in patients with RH, there were negative correlations between AS, ARC and GFR (r = -0.36, P < 0.05; r = -0.32, P < 0.05, respectively); positive – ARC and left ventricular mass index (r = 0.43, P < 0.05); AS and ACR (r = 0.76, Р < 0.01); AS and left ventricular end-diastolic volume (r = 0.38, P < 0.05). Moreover, significant correlations were found between ARC and BMI (r = 0.59, P < 0.001), AS and BMI (r = 0.42, P < 0.05).

Conclusions. The results indicate that in patients with RH, higher renin and AS levels are mediated by overweight as well as renin and AS have a different influence on target organs in RH. Furthermore, stimulation of AS production occurs regardless of the renin-angiotensin system and angiotensin II effects. The group of patients with RH is not homogeneous according to renin concentration and “low-renin” and “high-renin” hypertension are more frequently registered among them. It seems that pathophysiologic mechanisms are different in each case and need to be identified for the selection of antihypertensive agents to treat patients successfully.

References

Sheppard, J. P., Martin, U., & McManus, R. J. (2017) Diagnosis and Management of Resistant Hypertension. Heart, 29, P. 110–132.

Li, X. C., Zhang, J. F., & Zhuo, J. L. (2017) The vasoprotective axes of the renin-angiotensin system: physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases. Pharmacologic Research, 125, 21–38. doi: 10.1016/j.phrs.2017.06.005

Оbertynska, O. G. (2014) Klinichni aspekty rezystentnoi arterialnoi hipertenzii. [Clinical aspects of the resistant arterial hypertension]. Ukrainskyi kardiolohichnyi zhurnal, 4, 30–36. [in Ukrainian].

Hellman, P., & Hagström, E. (2014) Low-Renin Hypertension. Primary Aldosteronism. Springer, 39–44. doi: 10.1007/978-1-4939-0509-6_3

Rossi, G. P, Ceolotto, G., Rossitto, G., Seccia, T. M., Maiolino, G., Berton, C., et al. (2016) Prospective validation of an automated chemiluminescence-based assay of renin and aldosterone for the work-up of arterial hypertension. Clin Chem Lab Med., 54(9), 1441–50. doi: 10.1515/cclm-2015-1094

Muiesan, M. L., Salvetti, M., Rizzoni, D., Paini, A., Agabiti-Rosei, C., Aggiusti, C., & Agabiti Rosei, E. (2013) Resistant hypertension and target organ damage. Hypertens Res., 36(6), 485–91. doi: 10.1038/hr.2013.30

Hall, J. E., do Carmo, J. M., da Silva, A. A., Wang, Z., & Hall, M. E. (2015) Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circ Res., 116(6), 991–1006. doi: 10.1161/CIRCRESAHA.116.305697

Briones, A. M., Nguyen Dinh Cat, A., Callera, G. E., Yogi, A., Burger, D., & He, Y. (2012) Adipocytes pro- duce aldosterone through calcineurin-dependent signaling pathways: implications in diabetes mellitus-associated obesityand vascular dysfunction. Hypertension, 59(5), 1069–78. doi: 10.1161/HYPERTENSIONAHA.111.190223

Byrd, J. B., & Brook, R. D. (2014) A critical review of the evidence supporting aldostцerone in the etiology and its blockade in the treatment of obesity-associated hypertension. Journal of human hypertension, 28(1), 3–9. doi: 10.1038/jhh.2013.42

Asfarg, C. L., Nielsen, S. J., Andersen, U. B., Linneberg, A., Moller, D. V., Hedley, P. L., et al. (2013) Relative atrial natriuretic peptide deficiency and inadequate renin and angiotensin II suppression in obese hypertensive men. Hypertension, 62(1), 147–53. doi: 10.1161/HYPERTENSIONAHA.111.00791

Oliveras, A., Armario, P., Sans, L., Clarà, A., Vázquez, S., Molina, L. L., et al. (2018) Organ damage changes in patients with resistant hypertension randomized to renal denervation or spironolactone. The DENERVHTA (Denervación en Hipertensión Arterial) study. J Clin Hypertens (Greenwich), 20(1), 69–75. doi: 10.1111/jch.13156

Marcus, Y., Shefer, G., & Stern, N. (2013) Adipose tissue renin-angiotensin-aldosterone system (RAAS) and progression of insulin resistance. Molecular and Cellular Endocrinology, 378(1-2), 1–14. doi: 10.1016/j.mce.2012.06.021

Yang, T., & Xu, C. (2017) Physiology and pathophysiology of the intrarenal renin-angiotensin system: an update. J Am Soc Nephrol., 28(4), 1040–1049. doi: 10.1681/ASN.2016070734

Wile, D. (2012) Diuretics: a review. Ann Clin Biochem., 49, 419–431. doi: 10.1258/acb.2011.011281

Daugherty, S. L., Powers, D., Magid, D. J., Tavel, H. M., Masoudi, F. A., Margolis, K. L., et al. (2012). Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation., 125(13), 1635–42. doi: 10.1161/CIRCULATIONAHA.111.068064

Downloads

How to Cite

1.
Оbertynska ОH. The state of renin-aldosterone system in patients with resistant arterial hypertension. Zaporozhye medical journal [Internet]. 2019May31 [cited 2024Apr.20];(3). Available from: http://zmj.zsmu.edu.ua/article/view/168951

Issue

No. 3 (2019)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)