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Body Mass Index Predicts Plasma Aldosterone Concentrations in Overweight-Obese Primary Hypertensive Patients

DMCS Internal Medicine 4 (G.P.R., A.C.P.) and Endocrinology (F.M., A.P.), Azienda Ospedale Università, 35126 Padova Italy; Endocrinology (G.G., V.R., M.B.), Ospedale Umberto I, 60100 Ancona, Italy; Internal Medicine (E.R.), Azienda Ospedaliera ASMN, 42100 Reggio Emilia, Italy; Internal Medicine (G.B., A.M.), Ospedale Santa Chiara, 56100 Pisa, Italy; Department of Internal Medicine and Public Health (C.F., G.D.), University of L’Aquila, 67100 L’Aquila, Italy; Internal Medicine (G.A., G.C.), Policlinico Universitario, 90127 Palermo, Italy; Internal Medicine (D.R., E.P., E.A.-R.), Spedali Civili EULO, 25123 Brescia, Italy; Internal Medicine (G.P., C.C., M.T.L.), Ospedale Civile, 20025 Legnano, Italy; Internal Medicine, Department of Clinical Sciences (C.L., C.C.), University "La Sapienza", 00165 Roma, Italy; Internal Medicine (B.F.), Ospedale "Cattinara", 34121 Trieste, Italy; Endocrinology (M.M., G.P.), Azienda Ospedaliera "Careggi", 50139 Firenze, Italy; Endocrinology (M.M., E.G.), Ospedale "Molinette", 10126 Torino, Italy; Nephrology (F.M., G.C., C.Z.), Ospedale di Reggio Calabria, 89131 Reggio Calabria, Italy; and Internal Medicine (A.B.), Azienda Ospedaliera Policlinico, 70124 Bari, Italy

Address all correspondence and requests for reprints to: Professor Gian Paolo Rossi, M.D., F.A.C.C., F.A.H.A., DMCS-Clinica Medica 4, University Hospital, via Giustiniani, 2, 35126 Padova, Italy. E-mail: gianpaolo.rossi{at}unipd.it.

Context: Body mass index (BMI) shows a direct correlation with plasma aldosterone concentration (PAC) and urinary aldosterone excretion in normotensive individuals; whether the same applies to hypertensive patients is unknown.

Objective: Our objective was to determine if BMI predicts PAC and the PAC/plasma renin activity ratio [aldosterone renin ratio (ARR)] in hypertensive patients, and if this affects the identification of primary aldosteronism (PA).

Design: This was a prospective evaluation of consecutive hypertensive patients referred nationwide to specialized hypertension centers.

Main Outcome Measures: Sitting PAC, plasma renin activity, and the ARR, baseline and after 50 mg captopril orally with concomitant assessment of parameters, including BMI and daily sodium intake, were calculated.

Results: Complete biochemical data and a definite diagnosis were obtained in 1125 consecutive patients. Of them 999 had primary (essential) hypertension (PH) and 126 (11.2%) PA caused by an aldosterone-producing adenoma in 54 (4.8%). BMI independently predicted PAC (β = 0.153; P < 0.0001) in PH, particularly in the overweight-obese, but not in the PA group. Covariance analysis and formal comparison of the raw, and the BMI-, sex-, and sodium intake-adjusted ARR with receiver operator characteristic curves, showed no significant improvement for the discrimination of aldosterone-producing adenoma from PH patients with covariate-adjusted ARR.

Conclusions: BMI correlated with PAC independent of age, sex, and sodium intake in PH, but not in PA patients. This association of BMI is particularly evident in overweight-obese PH patients, and suggests a pathophysiological link between visceral adiposity and aldosterone secretion. However, it does not impact on the diagnostic accuracy of the ARR for discriminating PA from PH patients.