Cardiology, blood circulation, phlebology, Cardiologie, appareil circulatoire, phlébologie, Sciences biologiques et medicales, Biological and medical sciences, Sciences biologiques fondamentales et appliquees. Psychologie, Fundamental and applied biological sciences. Psychology, Vertebres: endocrinologie, Vertebrates: endocrinology, Rein endocrine. Système rénine-angiotensine-aldostérone, Endocrine kidney. Renin-angiotensin-aldosterone system, Sciences medicales, Medical sciences, Cardiologie. Appareil circulatoire, Cardiology. Vascular system, Vaisseaux sanguins et lymphatiques, Blood and lymphatic vessels, Hypertension artérielle. Hypotension artérielle, Arterial hypertension. Arterial hypotension, Clinique. Epidémiologie. Exploration. Etiologie, Clinical manifestations. Epidemiology. Investigative techniques. Etiology, Aspartic endopeptidases, Enzyme, Enzima, Hormone stéroïde, Steroid hormone, Hormona esteroide, Hormone surrénalienne, Adrenal hormone, Hormona suprarrenal, Hydrolases, Minéralocorticoïde, Mineralocorticoid, Mineralocorticoide, Peptidases, Aldostérone, Aldosterone, Aldosterona, Appareil circulatoire pathologie, Cardiovascular disease, Aparato circulatorio patología, Homme, Human, Hombre, Hypertension artérielle, Hypertension, Hipertensión arterial, Renin, Ventricule gauche, Left ventricle, Ventrículo izquierdo, aldosterone, ethnicity, and left ventricular hypertrophy
Background: Activity of the renin-angiotensin-aldosterone system is thought to play a major role in determining blood pressure (BP) and target organ damage such as left ventricular hypertrophy. In Afro-Caribbean subjects, however, hypertension tends to be more severe despite lower plasma renin activity. We investigated whether this might be due to a different relation between aldosterone and renin in Afro-Caribbean compared to white subjects. Methods: Plasma aldosterone and renin activity were assessed in the morning after 15 min seated in 383 hypertensive subjects of Afro-Caribbean or white ethnicity (61% Afro-Caribbean, 83% on treatment) attending a hypertension clinic in London, UK. Left ventricular mass index (LVMI) was assessed by echocardiography in 276 subjects. Results: Plasma renin activity was lower in Afro-Caribbean compared to white subjects (0.4 [0.3-1.0] v 1.4 [0.5-3.4] ng/mL/h, medians [interquartile range], P < .0001). Despite this, aldosterone was higher in Afro-Caribbean compared to white subjects (8.0 [6.1-12.6] v 7.4 [2.3-17.1] ng/dL, medians [interquartile range], P <.01). The LVMI corrected for sex and BP was higher in Afro-Caribbean than in white subjects. In Afro-Caribbean but not in white subjects LVMI was independently correlated with plasma aldosterone (standardized regression coefficient, p= 0.25, P <.001). Conclusions: In Afro-Caribbean hypertensive subjects in London, plasma aldosterone is elevated despite lower renin and may contribute to increased severity of hypertension and left ventricular hypertrophy in Afro-Caribbean compared to white subjects.