Arterial Pressure, Left Ventricular Mass, and Aldosterone in Essential Hypertension

Abstract

The purpose of the present study was to evaluate the relationship of aldosterone to blood pressure and left ventricular size in black American (n=109) and white French Canadian (n=73) patients with essential hypertension. Measurements were obtained with patients off antihypertensive medications and included 24-hour blood pressure monitoring, plasma renin activity and aldosterone, and an echocardiogram. Compared with the French Canadians, the black Americans had higher body mass indexes, higher systolic blood pressures, attenuated nighttime reduction of blood pressure, and lower serum potassium concentrations ( P <0.01 for each). Left ventricular mass index, posterior wall thickness, interventricular septal thickness, and relative wall thickness were also greater ( P <0.01 for each) in the black American patients. Supine and standing plasma renin activity was lower ( P <0.01 and P <0.05, respectively) in the black Americans, whereas supine plasma aldosterone concentrations did not differ, and standing plasma aldosterone was greater ( P <0.05) in the black Americans (9.2±0.7 ng/dL) than in the French Canadians (7.3±0.6 ng/dL). In the black Americans, supine plasma aldosterone was positively correlated with nighttime systolic ( r =0.30; P <0.01) and diastolic ( r =0.39; P <0.001) blood pressures and inversely correlated with the nocturnal decline of systolic ( r =−0.29; P <0.01) and diastolic ( r =−0.37; P <0.001) blood pressures. In the black Americans, standing plasma aldosterone was positively correlated with left ventricular mass index ( r =0.36; P <0.001), posterior wall thickness ( r =0.33; P <0.01), and interventricular septal thickness ( r =0.26; P <0.05). When the black American patients were divided into obese and nonobese groups, significant correlations between plasma aldosterone and both blood pressure and cardiac mass were observed only in the obese. In the French Canadians, overall, plasma aldosterone did not correlate with either blood pressure or any measures of heart size. However, among obese French Canadians, supine plasma aldosterone correlated with nighttime diastolic ( r =0.53, P <0.02) and systolic ( r =0.44, P <0.01) blood pressures but not with cardiac mass. These results are consistent with the hypothesis that aldosterone contributes to elevated arterial pressure in obese black American and obese white French Canadian patients with essential hypertension and to the attenuated nocturnal decline of blood pressure and left ventricular hypertrophy in obese, hypertensive black Americans.