Journal Article

Bimodal Aldosterone Distribution in Low-Renin Hypertension

E. Victor Adlin, Leonard E. Braitman and Ramachandran S. Vasan

in American Journal of Hypertension

Published on behalf of American Journal of Hypertension, Ltd.

Volume 26, issue 9, pages 1076-1085
Published in print September 2013 | ISSN: 0895-7061
Published online June 2013 | e-ISSN: 1941-7225 | DOI: https://dx.doi.org/10.1093/ajh/hpt091
Bimodal Aldosterone Distribution in Low-Renin Hypertension

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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 ≥140mm Hg or DBP ≥90mm 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.

Keywords: aldosterone; blood pressure; hypertension; low-renin hypertension; renin.

Journal Article.  3495 words.  Illustrated.

Subjects: Cardiovascular Medicine ; Biological Sciences

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