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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 1, January/February 2019
AFRICA
39
aldosterone and its relationship with the sympathetic nervous
system.
This work was supported by HART, North-West University, South Africa;
the Metabolic Syndrome Institute, France; Medical Research Council, South
Africa; Roche Diagnostics, South Africa; and the North West Department
of Education. The financial assistance of the National Research Foundation
(NRF) towards this research is hereby acknowledged. Opinions expressed and
conclusions arrived at are those of the authors and are not necessarily to be
attributed to the NRF.
References
1.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H,
et
al
. A comparative risk assessment of burden of disease and injury attrib-
utable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010:
a systematic analysis for the Global Burden of Disease Study 2010.
Lancet
2013;
380
: 2224–2260.
2.
Danaei G, Finucane MM, Lin JK, Singh GM, Paciorek CJ, Cowan MJ,
et al
. National, regional, and global trends in systolic blood pressure
since 1980: systematic analysis of health examination surveys and epide-
miological studies with 786 country-years and 5.4 million participants.
Lancet
2011;
377
: 568–577.
3.
Richardson SI, Freedman BI, Ellison DH, Rodriguez CJ. Salt sensitiv-
ity: a review with a focus on non-Hispanic blacks and Hispanics.
J Am
Soc Hypertens
2013;
7
: 170–179.
4.
Funder JW. Sensitivity to aldosterone plasma levels are not the full story.
Hypertension
2014;
63
: 1168–1170.
5.
Murphy MB, Fumo MT, Gretler DD, Nelson KS, Lang RM. Diurnal
blood pressure variation: differences among disparate ethnic groups.
J
Hypertens
1991;
9
: S45–S47.
6.
Mayet J, Chapman N, Li CK, Shahi M, Poulter NR, Sever PS,
et al
.
Ethnic differences in the hypertensive heart and 24-hour bloos pressure
profile.
Hypertension
1998;
31
: 1190–1194.
7.
Gordon RD, Laragh JH, Funder JW. Low renin hypertensive states:
perspectives, unsolved problems, future research.
Trends Endocrinol
Metabol
2005;
16
: 108–113.
8.
Gordon RD. Mineralocorticoid excess syndromes. In: Margerison, AN
& Chrousos, GP (eds).
Adrenal Disorders
. New York: Springer, 2001:
355–377.
9.
Pilz S, Tomaschitz A, März W. Diagnostic procedures for primary aldo-
steronism.
Lab Medizin
2009;
33
: 202–209.
10. Scott L, Woodiwiss AJ, Maseko MJ, Veliotes DG, Majane OH, Paiker
J,
et al
. Aldosterone-to-renin ratio and the relationship between urinary
salt excretion and blood pressure in a community of African ancestry.
Am J Hypertens
2011;
24
: 951–957.
11. Huan Y, DeLoach S, Keith SW, Goodfriend TL, Falkner B. Aldosterone
and aldosterone: renin ratio associations with insulin resistance and blood
pressure in African Americans.
J Am Soc Hypertens
2012;
6
: 56–65.
12. Polonia J, Diogo DI, Caupers P, Damasceno A. Influence of two
doses of irbesartan on non-dipper circadian blood pressure rhythm
in salt-sensitive black hypertensives under high salt diet.
J Cardiovasc
Pharmacol
2003;
42
: 98–104.
13. Tu W, Eckert GJ, Hannon TS, Liu H, Pratt LM, Wagner MA,
et
al
. Racial differences in sensitivity of blood pressure to aldosterone.
Hypertension
2014;
63
: 1212–1218.
14. Yee K, Struthers A. Aldosterone blunts the baroreflex response in man.
Clin Sci
1998;
95
: 687–692.
15. Weber MA, Purdy RE. Catecholamine-mediated constrictor effects of
aldosterone on vascular smooth muscle.
Life Sci
1982;
30
: 2009–2017.
16. Yee K-M, Pringle SD, Struthers AD. Circadian variation in the effects
of aldosterone blockade on heart rate variability and QT dispersion in
congestive heart failure.
J Am Coll Cardiol
2001;
37
: 1800–1907.
17. Grassi G, Vailati S, Bertinieri G, Seravalle G, Stella ML, Dell’Oro R,
Mancia G. Heart rate as marker of sympathetic activity.
J Hypertens
1998;
16
: 1635–1639.
18. Eguchi K, Hoshide S, Ishikawa J, Pickering TG, Schwartz JE, Shimada
K, Kario K. Nocturnal non-dipping of heart rate predicts cardiovascu-
lar events in hypertensive patients.
J Hypertens
2009;
27
: 2265.
19. Malan L, Hamer M, Frasure-Smith N, Steyn HS, Malan NT. Cohort
profile: Sympathetic activity and Ambulatory Blood Pressure in Africans
(SABPA) prospective cohort study.
Int J Epidemiol
2015;
44
: 1814–1822.
20. Marfell-Jones T, Olds T, Carter A. International standards for anthro-
pometric assessment. International Society for the Advancement of
Kinanthropometry (ISAK), 2006.
21. Imholz BP, Wieling W, van Montfrans GA, Wesseling KH. Fifteen
years’ experience with finger arterial pressure monitoring: assessment of
the technology.
Cardiovasc Res
1998;
38
: 605–616.
22. Guelen I, Westerhof BE, van der Sar GL, van Montfrans GA,
Kiemeneij F, Wesseling KH, Bos WJW. Validation of brachial artery
pressure reconstruction from finger arterial pressure.
J Hypertens
2008;
26
: 1321–1327.
23. Parati G, Esler M. The human sympathetic nervous system: its relevance
in hypertension and heart failure.
Eur Heart J
2012;
33
: 1058–1066.
24. Hildebrandt DA, Irwin ED, Cates AW, Lohmeier TE. Regulation of
renin secretion and arterial pressure during prolonged baroreflex activa-
Table 5. Independent associations of 24-hour BP and noradrenaline:creatinine ratio with renin, aldosterone and ARR in black and white groups
Independent variables
Blacks (
n
=
127)
24-h SBP
24-h DBP
Log noradrenaline:creatinine ratio
Adjusted R
2
β
(95% CI)
p
-value Adjusted R
2
β
(95% CI)
p
-value Adjusted R
2
β
(95% CI)
p
-value
Log renin
0.31
–0.22 (–19.3; –3.44)
0.006
0.37
–0.20 (–12.4; –1.88)
0.009
0.10
–
–
Log aldosterone
0.28
–
–
0.34
–
–
0.12
0.19 (0.0005 ; 0.16)
0.051
Log ARR
0.28
0.11 (–1.59; 9.53 )
0.16
0.35
0.14 (–0.23; 6.89)
0.070
0.10
0.10 (–0.03 ; 0.10)
0.31
Whites (
n
=
179)
24-h SBP
24-h DBP
Log noradrenaline:creatinine ratio
Adjusted R
2
β
(95% CI)
p
-value Adjusted R
2
β
(95% CI)
p
-value Adjusted R
2
β
(95% CI)
p
-value
Log renin
0.29
–0.15 (–13.9; –1.20)
0.021
0.28
–0.16 (–9.71; –0.93)
0.019
0.34
0.08 (–0.03; 0.13)
0.22
Log aldosterone
0.28
–0.11 (–9.52; 0.96)
0.11
0.27
–0.07 (–5.61; 1.69)
0.29
0.34
–
–
Log ARR
0.27
–
–
0.26
–
–
0.34
–0.09 (–0.10 ; 0.02)
0.16
–, log renin, log aldosterone and log ARR did not enter the forward stepwise model. Independent variables included in the model: age, waist-to-hip ratio, gender,
gamma-glutamyltransferase, cotinine, urinary Na
+
:K
+
ratio; total cholesterol: high-density lipoprotein cholesterol ratio, glycosylated haemoglobin, tumour necrosis
factor-
α
, estimated glomerular filtration rate, total peripheral resistance. ARR, aldosterone-to-renin ratio; SBP, systolic blood pressure; DBP, diastolic blood pressure.
Values in bold indicate
p
<
0.05.