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This version published online on April 29, 2008
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2008-0251
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Submitted on February 4, 2008
Accepted on April 21, 2008

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

Gian Paolo Rossi*, Anna Belfiore, Giampaolo Bernini, Bruno Fabris, Graziella Caridi, Claudio Ferri, Gilberta Giacchetti, Claudio Letizia, Mauro Maccario, Massimo Mannelli, Gaetana Palumbo, Anna Patalano, Damiano Rizzoni, Ermanno Rossi, Achille C. Pessina, Franco Mantero, and for the PAPY Study Investigators

University of Padua (G.P.R., A.P., A.C.P., F.M.); University of Bari (A.B.); University of Pisa (G.B.); University of Trieste (B.F.); Hospital of Reggio Calabria (G.C.); University of L'Aquila (C.F.); University of Ancona (G.G.); University of Rome (C.L.); University of Torino (M.Mac.); University of Florence (M.Man.); Medicina Interna Ospedale di Legnano (G.P.); University of Brescia (D.R.); and Ospedale di Reggio Emilia (E.R.)

* To whom correspondence should be addressed. 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.

Objectives. To determine if BMI predicts PAC and the PAC/plasma renin activity (PRA) ratio (ARR) in hypertensive patients and if this affects the identification of primary aldosteronism.

Design. Prospective evaluation of consecutive hypertensive patients referred nationwide to specialized hypertension centers.

Main outcome measures. Sitting PAC, PRA, and the ARR, baseline and after 50 mg captopril orally with concomitant assessment of parameters including BMI and daily sodium intake.

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%) primary aldosteronism (PA) caused by an aldosterone-producing adenoma in 54 (4.8%).

BMI independently predicted PAC ({beta} = 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 ROC curves, showed no significant improvement for the discrimination of APA 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 effect 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.
Key words: aldosterone • body mass index • arterial hypertension • obesity • aldosteronism






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