Aldosterone, Parathyroid Hormone, and the Use of Renin-Angiotensin-Aldosterone System Inhibitors: The Multi-Ethnic Study of Atherosclerosis
Open accessAbstract
Context: Aldosterone and PTH are implicated in the pathogenesis of cardiovascular and skeletal diseases. An expanding body of evidence supports a bidirectional and positive physiologic relationship between aldosterone and PTH. Large population-based studies confirming this relationship, and whether it may be targeted as a potential method to mitigate the clinical consequences associated with excess aldosterone and PTH, are needed. Objective: We hypothesized that higher aldosterone levels would associate with higher PTH, and that the use of renin-angiotensin-aldosterone system (RAAS) inhibitors would predict lower PTH in a large, multi-ethnic, community-based cohort. Design, Setting, Participants: We conducted cross-sectional analyses of participants in the Multi-Ethnic Study of Atherosclerosis without apparent primary hyperparathyroidism or chronic kidney disease (n = 5668). We evaluated associations of RAAS inhibitor use with PTH concentration among 1888 treated hypertensive participants. We also tested associations of serum aldosterone concentration with PTH concentration among 1547 participants with these measurements. Outcome: Serum PTH concentration. Results: Higher aldosterone associated with higher PTH (β = 0.19 pg/ml per 1 ng/dl of aldosterone, P < .0001), and this finding was most pronounced among those with a primary hyperaldosteronism-like phenotype. There was a stepwise increment in PTH when comparing untreated normotensives, hypertensives using RAAS inhibitors, untreated hypertensives, and treated hypertensives using non-RAAS inhibitors (40.8, 45.0, 46.2, 47.1 pg/ml, respectively). The use of any RAAS inhibitor independently associated with lower PTH (β = −2.327 pg/ml per use of RAAS inhibitor, P = .006), when compared with the use of any non-RAAS inhibitor medication. Conclusions: Higher serum aldosterone concentration is associated with higher serum PTH concentration, and the use of RAAS inhibitors is associated with lower PTH concentration. These results extend prior evidence from observational and intervention studies suggesting a potentially important and modifiable relationship between the RAAS and PTH in humans.
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Angiotensin-Converting Enzyme Inhibition and Parathyroid Hormone Secretion
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Parathyroid hormone may play a role in the pathophysiology of primary hypertension
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Vitamin D–Parathyroid Hormone–Fibroblast Growth Factor 23 Axis and Cardiac Remodeling
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Aldosterone is a possible new stimulating factor for promoting vascular calcification
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The Relationship Between Renal Stones and Primary Aldosteronism
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High-Phytate Diets Increase Amyloid β Deposition and Apoptotic Neuronal Cell Death in a Rat Model
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Self-citationChanges in PTH Across the Spectrum of Renin-independent Aldosteronism
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- Authors
- Brown, J., de Boer, I. H., Robinson-Cohen, C., Siscovick, D. S., Kestenbaum, B., Allison, M., & Vaidya, A.
- Affiliations
- Brigham and Women's Hospital (US)
- Department of Medicine, Kidney Research Institute (I.H.d.B., C.R.-C., B.K.), University of Washington, Seattle, Washington 98104
- New York Academy of Medicine (US)
- University of Washington (US)
- Veterans Health Administration (US)
- Corresponding author
- Vaidya, Anand
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2015-02-01
- Volume
- 100
- Issue
- 2
- Pages
- 490-499
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC4318894
- OpenAlex
- W2090955044
- Cited by
- 71
- References
- 55
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 4 · 2022: 5 · 2021: 7 · 2020: 10 · 2019: 9 · 2018: 6 · 2017: 8 · 2016: 6 · 2015: 7 · 2014: 1 · 2013: 1
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc095169-003, n01hc95166-21-0-1, n01hc95159-40-0-1)
- National Heart, Lung, and Blood Institute (N01 HC-95159, R01HL096875, N01-HC095169, R01HL071739, L30 HL104553, N01-HC-095159, R01HL072403, K23 HL11177, N01 HC095166, N01‐HC‐95166, K23HL111771, N01 HC95169)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK035816)
- National Center for Research Resources (UL1RR025758)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Keywords
- aldosterone, parathyroid hormone, renin-angiotensin-aldosterone system inhibitors, primary aldosteronism, hypertension, serum PTH, serum aldosterone, Multi-Ethnic Study of Atherosclerosis, cardiovascular disease, bone disease
- MeSH terms
- Aged, Aged, 80 and over, Aldosterone, Mineralocorticoid Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Asian, Black or African American, Cross-Sectional Studies, Female, Hispanic or Latino, Humans, Male, Middle Aged, Parathyroid Hormone, Renin-Angiotensin System, White People, Atherosclerosis
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