Cited by 301Hormonal Regulation and HypertensionRenin-Angiotensin System StudiesBlood Pressure and Hypertension Studies

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Characterization of Resistant Hypertension<subtitle>Association Between Resistant Hypertension, Aldosterone, and Persistent Intravascular Volume Expansion</subtitle>

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Gaddam, Krishna K.·2008·Archives of Internal Medicine

DOI 10.1001/archinte.168.11.1159PMC PMC2748247

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Abstract

BACKGROUND: Resistant hypertension is a common clinical problem and greatly increases the risk of target organ damage. METHODS: We evaluated the characteristics of 279 consecutive patients with resistant hypertension (uncontrolled despite the use of 3 antihypertensive agents) and 53 control subjects (with normotension or hypertension controlled by using <or=2 antihypertensive medications). Participants were prospectively examined for plasma aldosterone concentration, plasma renin activity, aldosterone to renin ratio, brain-type natriuretic peptide, atrial natriuretic peptide, and 24-hour urinary aldosterone (UAldo), cortisol, sodium, and potassium values while adhering to a routine diet. RESULTS: Plasma aldosterone (P < .001), aldosterone to renin ratio (P < .001), 24-hour UAldo (P = .02), brain-type natriuretic peptide (P = .007), and atrial natriuretic peptide (P = .001) values were higher and plasma renin activity (P = .02) and serum potassium (P < .001) values were lower in patients with resistant hypertension vs controls. Of patients with resistant hypertension, men had significantly higher plasma aldosterone (P = .003), aldosterone to renin ratio (P = .02), 24-hour UAldo (P < .001), and urinary cortisol (P < .001) values than women. In univariate linear regression analysis, body mass index (P = .01), serum potassium (P < .001), urinary cortisol (P < .001), urinary sodium (P = .02), and urinary potassium (P < .001) values were correlated with 24-hour UAldo levels. Serum potassium (P = .001), urinary potassium (P < .001), and urinary sodium (P = .03) levels were predictors of 24-hour UAldo levels in multivariate modeling. CONCLUSIONS: Aldosterone levels are higher and there is evidence of intravascular volume expansion (higher brain-type and atrial natriuretic peptide levels) in patients with resistant hypertension vs controls. These differences are most pronounced in men. A significant correlation between 24-hour urinary aldosterone levels and cortisol excretion suggests that a common stimulus, such as corticotropin, may underlie the aldosterone excess in patients with resistant hypertension.

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Authors: Gaddam, K. K.
Affiliations: University of Alabama at Birmingham (US)
Corresponding author: Gaddam, Krishna K.
Venue: Archives of Internal Medicine
Publisher: American Medical Association (AMA)
Published: 2008-06-09
Volume: 168
Issue: 11
Pages: 1159
ISSN: 0003-9926 (ISSN-L)
DOI: 10.1001/archinte.168.11.1159
PMC: PMC2748247
OpenAlex: W2118344567
Cited by: 301
References: 32
Citations by year: 2026: 16 · 2025: 10 · 2024: 9 · 2023: 18 · 2022: 12 · 2021: 10 · 2020: 13 · 2019: 13 · 2018: 19 · 2017: 21 · 2016: 20 · 2015: 19 · 2014: 21 · 2013: 24 · 2012: 22
FWCI: 13.02
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Archives of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Heart, Lung, and Blood Institute (HL-007457, HL077100, HL-075614, R01HL075614, P50HL077100, T32HL007457)
National Center for Research Resources (M01RR00032, M01RR000032)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords: resistant hypertension, plasma aldosterone, aldosterone-renin ratio, plasma renin activity, brain natriuretic peptide, atrial natriuretic peptide, intravascular volume expansion, urinary cortisol, serum potassium, urinary sodium, sex differences, body mass index, target organ damage, aldosterone excess
MeSH terms: Aldosterone, Antihypertensive Agents, Drug Resistance, Female, Humans, Hydrocortisone, Hypertension, Male, Middle Aged, Atrial Natriuretic Factor, Potassium, Regression Analysis, Renin, Sex Factors, Sodium, Case-Control Studies, Natriuretic Peptide, Brain

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