Key result
A 1-unit higher log-plasma renin activity was associated with lower odds of daytime hypertension (OR 0.59; 95% CI 0.49-0.71) in African Americans.
Why the study?
The association of the renin-angiotensin-aldosterone system with ambulatory blood pressure and ambulatory blood pressure monitoring phenotypes among African Americans had not been assessed.
Cohort (n=912)
Odds Ratio: 0.59 (95% CI 0.49–0.71)
p-value: p=<0.05
In African Americans, suppressed renin activity and higher aldosterone levels are associated with higher ambulatory blood pressure and adverse hypertension phenotypes, suggesting a potential role for targeted therapies like mineralocorticoid receptor antagonists.
RAAS-ABP phenotype associations in African Americans are hypothesis-generating; prospective studies needed before clinical consideration.
BACKGROUND: The renin-angiotensin-aldosterone system (RAAS) is an important driver of blood pressure (BP), but the association of the RAAS with ambulatory BP (ABP) and ABP monitoring phenotypes among African Americans has not been assessed. METHODS: ABP and ABP monitoring phenotypes were assessed in 912 Jackson Heart Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analyses were used to analyze the association of aldosterone and PRA with clinic, awake, and asleep systolic BP and diastolic BP (DBP) and ABP monitoring phenotypes, adjusting for important confounders. RESULTS: <0.05). A 1-unit higher log-PRA was associated with lower odds of daytime hypertension (odds ratio [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 was associated with percent dipping, nondipping BP pattern, or white-coat hypertension. Patterns for aldosterone:renin ratio were similar to patterns for PRA. CONCLUSIONS: Suppressed renin activity and higher aldosterone:renin ratios were associated with higher systolic BP and DBP in the office and during the awake and asleep periods as evidenced by ABP monitoring. Higher aldosterone levels were associated with higher DBP, but not systolic BP, 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 African Americans.
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A 2021 study conducted a cohort in Hypertension (n=912). Plasma renin activity and serum aldosterone vs. Lower levels (continuous analysis) was evaluated on Daytime hypertension (OR 0.59, 95% CI 0.49-0.71, p=<0.05). A 1-unit higher log-plasma renin activity was associated with lower odds of daytime hypertension (OR 0.59; 95% CI 0.49-0.71) in African Americans.
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