scholarly journals Characterization of the Renin-Angiotensin-Aldosterone System in Young Healthy Black Adults: The African Prospective Study on the Early Detection and Identification of Hypertension and Cardiovascular Disease (African-PREDICT Study)

Hypertension ◽  
2021 ◽  
Author(s):  
Lebo F. Gafane-Matemane ◽  
Ruan Kruger ◽  
Wayne Smith ◽  
Catharina M.C. Mels ◽  
Johannes M. Van Rooyen ◽  
...  
Keyword(s):  
Total Peripheral Resistance ◽  
Peripheral Resistance ◽  
Left Ventricular ◽  
Internal Diameter ◽  
Black Adults ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Black And White ◽  
White Adults ◽  
Over Time

This study presents a detailed profile of the renin-angiotensin-aldosterone system (RAAS), electrolytes, volume loading, blood pressure (BP), and total peripheral resistance in healthy young Black and White adults. We also explored longitudinal associations between BP and RAAS. We included normotensive Black (N=543) and White (N=573) adults (20–30 years) and followed N=324 over ≈4.5 years. We measured clinic (central, brachial) and 24-hour BP, total peripheral resistance and left ventricular dimensions. We determined serum NT-proBNP (N-terminal prohormone B-type natriuretic peptide), RAAS, and 24-hour urinary and serum Na + and K + . RAAS components, left ventricular internal diameter (diastole), end diastolic volume and NT-proBNP were lower ( P <0.001) in Black than White adults, despite similar clinic SBP. However, central systolic BP and total peripheral resistance were higher in Black adults ( P <0.001). Plasma renin activity and angiotensin II were comparable between Black and White groups ( P >0.05) only in quartile 1 of Na + /K + values. In both groups, RAAS was lower in the higher quartiles of 24-hour Na + and NT-proBNP (all P -trend≤0.014). Over 4.5 years, all BPs increased in the Black ( P <0.001) but not White group. The increase in central systolic BP over time was associated with elevated serum aldosterone only in Black adults (β=0.18, P =0.038). We found that RAAS concentrations in healthy Black adults were half of those of White participants, which may not be explained by volume expansion. Yet, baseline aldosterone predicted BP elevation over time in Black adults. RAAS was similar in Black and White adults only at low Na + /K + scenarios, suggesting an essential role of potassium. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03292094.

scholarly journals Superiority of Out-of-Office Blood Pressure for Predicting Hypertensive Heart Disease in Non-Hispanic Black Adults

Hypertension ◽  
2019 ◽  
Vol 74 (5) ◽  
pp. 1192-1199 ◽  
Author(s):  
Florian Rader ◽  
Stanley S. Franklin ◽  
James Mirocha ◽  
Wanpen Vongpatanasin ◽  
Robert W. Haley ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Disease ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Office Blood Pressure ◽  
Black Adults ◽  
Black And White ◽  
White Adults

Black Americans suffer disproportionately from hypertension and hypertensive heart disease. Out-of-office blood pressure (BP) is more predictive for cardiovascular complications than clinic BP; however, the relative abilities of clinic and out-of-office BP to predict left ventricular hypertrophy in black and white adults have not been established. Thus, we aimed to compare associations of out-of-office and clinic BP measurement with left ventricular hypertrophy by cardiac magnetic resonance imaging among non-Hispanic black and white adults. In this cross-sectional study, 1262 black and 927 white participants of the Dallas Heart Study ages 30 to 64 years underwent assessment of standardized clinic and out-of-office (research staff-obtained) BP and left ventricular mass index. In multivariable-adjusted analyses of treated and untreated participants, out-of-office BP was a stronger determinant of left ventricular hypertrophy than clinic BP (odds ratio per 10 mm Hg, 1.48; 95% CI, 1.34–1.64 for out-of-office systolic BP and 1.15 [1.04–1.28] for clinic systolic BP; 1.71 [1.43–2.05] for out-of-office diastolic BP, and 1.03 [0.86–1.24] for clinic diastolic BP). Non-Hispanic black race/ethnicity, treatment status, and lower left ventricular ejection fraction were also independent determinants of hypertrophy. Among treated Blacks, the differential association between out-of-office and clinic BP with hypertrophy was more pronounced than in treated white or untreated participants. In conclusion, protocol-driven supervised out-of-office BP monitoring provides important information that cannot be gleaned from clinic BP assessment alone. Our results underscore the importance of hypertension management programs outside the medical office to prevent hypertensive heart disease, especially in high-risk black adults. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT00344903.

scholarly journals The Role of Stressful Childhood Experiences in Shaping Later-Life Memory Loss Among Black and White U.S. Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 296-296
Author(s):  
Caroline Hartnett
Keyword(s):  
Cognitive Decline ◽  
Memory Loss ◽  
Later Life ◽  
Behavioral Risk ◽  
Black Adults ◽  
Childhood Experiences ◽  
White Children ◽  
Black And White ◽  
Stressful Experiences ◽  
White Adults

Abstract Cognitive decline common in the U.S. and greatly impacts quality of life, both for those who experience it and for those who care for them. Black Americans experience higher burdens of cognitive decline but the mechanisms underlying this disparity have not been fully elucidated. Stress experienced in early life is a promising explanatory factor, since stress and cognition are linked, childhood stressors been shown to have a range of negative implications later in life, and Black children experience more childhood stressors than White children, on average. In this paper, we use data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine whether stressful experiences in childhood help explain Black-White disparities in memory loss. These data were available for 5 state-years between 2011 and 2017 (n=11,708). Preliminary results indicate that, while stressful childhood experiences are strongly associated with memory loss, stressful experiences do not mediate the association between race and memory loss. However, race does appear to moderate the association between stressful childhood experiences and memory loss. Specifically, stressful experiences are associated with a higher likelihood of memory loss for Black adults compared to White adults.In addition, there seem to be some noteworthy patterns across different types of experiences (i.e. parental drinking may predict later memory loss more strongly for Black adults than White adults, but parental hitting may predict memory loss more strongly for White adults than Black adults).

scholarly journals Impact of Renin-Angiotensin-Aldosterone System Gene Polymorphisms on Left Ventricular Dysfunction in Coronary Artery Disease Patients

2012 ◽  
Vol 32 (1) ◽  
pp. 33-41 ◽  
Author(s):  
Avshesh Mishra ◽  
Anshika Srivastava ◽  
T. Mittal ◽  
N. Garg ◽  
B. Mittal
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Output ◽  
Coronary Artery ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
P Value ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Artery Disease

Background: Left ventricular dysfunction (LVD), followed by fall in cardiac output is one of the major complications in some coronary artery disease (CAD) patients. The decreased cardiac output over time leads to activation of the renin-angiotensin-aldosterone system which results in vasoconstriction by influencing salt-water homeostasis. Therefore, the purpose of the present study was to explore the association of single nucleotide polymorphisms (SNPs) in angiotensin I converting enzyme;ACE(rs4340), angiotensin II type1 receptor; AT1 (rs5186) and aldosterone synthase;CYP11B2(rs1799998) with LVD.Methods and results: The present study was carried out in two cohorts. The primary cohort included 308 consecutive patients with angiographically confirmed CAD and 234 healthy controls. Among CAD, 94 with compromised left ventricle ejection fraction (LVEF ≤ 45) were categorized as LVD. The ACE I/D, AT1 A1166C andCYP11B2T-344C polymorphisms were determined by PCR. Our results showed that ACE I/D was significantly associated with CAD but not with LVD. However, AT1 1166C variant was significantly associated with LVD (LVEF ≤ 45) (p value=0.013; OR=3.69), butCYP11B2(rs1799998) was not associated with either CAD or LVD. To validate our results, we performed a replication study in additional 200 cases with similar clinical characteristics and results again confirmed consistent findings (p value=0.020; OR=5.20).Conclusion: AT1 A1166C plays important role in conferring susceptibility of LVD.

scholarly journals MicroRNAs Regulating Renin–Angiotensin–Aldosterone System, Sympathetic Nervous System and Left Ventricular Hypertrophy in Systemic Arterial Hypertension

Biomolecules ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 1771
Author(s):  
Alex Cleber Improta-Caria ◽  
Marcela Gordilho Aras ◽  
Luca Nascimento ◽  
Ricardo Augusto Leoni De Sousa ◽  
Roque Aras-Júnior ◽  
...  
Keyword(s):  
Nervous System ◽  
Sympathetic Nervous System ◽  
Left Ventricular Hypertrophy ◽  
Signaling Pathways ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Gene And Protein Expression ◽  
Sympathetic Nervous

MicroRNAs are small non-coding RNAs that regulate gene and protein expression. MicroRNAs also regulate several cellular processes such as proliferation, differentiation, cell cycle, apoptosis, among others. In this context, they play important roles in the human body and in the pathogenesis of diseases such as cancer, diabetes, obesity and hypertension. In hypertension, microRNAs act on the renin–angiotensin–aldosterone system, sympathetic nervous system and left ventricular hypertrophy, however the signaling pathways that interact in these processes and are regulated by microRNAs inducing hypertension and the worsening of the disease still need to be elucidated. Thus, the aim of this review is to analyze the pattern of expression of microRNAs in these processes and the possible associated signaling pathways.

Role of the Renin-Angiotensin-Aldosterone System and the Glutathione S-Transferase Mu, Pi and Theta Gene Polymorphisms in Cardiotoxicity after Anthracycline Chemotherapy for Breast Carcinoma

2013 ◽  
Vol 28 (4) ◽  
pp. 336-347 ◽  
Author(s):  
Daniela Vivenza ◽  
Mauro Feola ◽  
Ornella Garrone ◽  
Martino Monteverde ◽  
Marco Merlano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gene Polymorphisms ◽  
Left Ventricular ◽  
Detoxification Enzymes ◽  
Left Ventricular Ejection ◽  
Glutathione S Transferase ◽  
Renin Angiotensin Aldosterone System ◽  
Ventricular Ejection Fraction ◽  
Renin Angiotensin ◽  
Anthracycline Chemotherapy

Background Anthracyclines are among the most active drugs against breast cancer, but can exert cardiotoxic effects eventually resulting in congestive heart failure (CHF). Identifying breast cancer patients at high risk of developing cardiotoxicity after anthracycline therapy would be of value in guiding the use of these agents. Aims We determined whether polymorphisms in the renin-angiotensin-aldosterone system (RAAS) and in the glutathione S-transferase (GST) family of phase II detoxification enzymes might be useful predictors of left ventricular ejection fraction (LVEF) kinetics and risk of developing CHF. We sought correlations between the development of cardiotoxicity and gene polymorphisms in 48 patients with early breast cancer treated with adjuvant anthracycline chemotherapy. Methods We analyzed the following polymorphisms: p.Met235Thr and p.Thr174Met in angiotensinogen ( AGT), Ins/Del in angiotensin-converting enzyme ( ACE), A1166C in angiotensin II type-1 receptor ( AGTR1A), c.-344T>C in aldosterone synthase ( CYP11B2), p.Ile105Val in GSTP1. Additionally, we analyzed the presence or absence of the GSTT1 and GSTP1 genes. A LVEF <50% was detected at least once during the 3 years of follow-up period in 13 out of 48 patients (27.1%). Conclusion RAAS gene polymorphisms were not significantly associated with the development of cardiotoxicity. GSTM1 may be useful as a biomarker of higher risk of cardiotoxicity, as demonstrated in our cohort of patients (p=0.147).

Left ventricular mass and urinary metabolomics in young black and white adults: The African-PREDICT study

2020 ◽  
Vol 30 (11) ◽  
pp. 2051-2062
Author(s):  
Dalene De Beer ◽  
Catharina MC. Mels ◽  
Aletta E. Schutte ◽  
Roan Louw ◽  
Christian Delles ◽  
...  
Keyword(s):  
Left Ventricular Mass ◽  
Left Ventricular ◽  
Black And White ◽  
Ventricular Mass ◽  
White Adults ◽  
Predict Study

scholarly journals Left ventricular and proximal aorta coupling in magnetic resonance imaging: aging together?

2019 ◽  
Vol 317 (2) ◽  
pp. H300-H307 ◽  
Author(s):  
Alban Redheuil ◽  
Nadjia Kachenoura ◽  
Emilie Bollache ◽  
Wen-Chung Yu ◽  
Anders Opdahl ◽  
...  
Keyword(s):  
Total Peripheral Resistance ◽  
Characteristic Impedance ◽  
Myocardial Strain ◽  
Peripheral Resistance ◽  
Wall Stress ◽  
Aortic Distensibility ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Left Ventricular Geometry ◽  
Age Related

The importance of aorta-ventricular coupling in cardiovascular disease is recognized but underestimated. The contribution of the age-related decline in ascending aortic function compared with characteristic impedance and total peripheral resistance on left ventricular function and remodeling is poorly studied. Our aim was to evaluate the relation of proximal aortic distensibility and impedance with left ventricular geometry and function in asymptomatic individuals. We prospectively studied 100 subjects (47 men, 53 women, age: 20–84 yr). Aortic strain, distensibility, arch pulse wave velocity, characteristic impedance ( Zc), total peripheral resistance, left ventricular (LV) volumes and mass, wall stress, and peak global circumferential myocardial strain and strain rates were determined by MRI. Central pressures were measured from tonometry. Ea/ Ev, an index of vascular-ventricular coupling, and LV wall stress were preserved across age- or aortic-stiffness-stratified groups. Static and pulsatile components of aortic load were differentially associated with age. Increased total vascular resistance was associated with decreased LV strain and increased concentric remodeling [ratio of LV mass to end-diastolic volume (M/V ratio)] in all individuals. In younger individuals (<45 yr), aortic distensibility was related to LV strain and concentric remodeling (M/V ratio), whereas Zc was related to LV strain and concentric remodeling (M/V ratio) in older individuals (>45 yr). Early age-related stiffening of the ascending aorta is a component of LV afterload subsequently associated with increased aortic impedance and alterations in LV geometry, namely concentric remodeling, decreased myocardial strain, and increased stroke work such that LV wall stress and arterial-ventricular coupling are preserved. NEW & NOTEWORTHY Local flow and deformation can both be assessed with high precision noninvasively in the ascending aorta using MRI. Combined with central pressure measurement, they provide distensibility and impedance and simultaneous reference assessment of left ventricular deformation and geometry, hence a comprehensive evaluation of arterial-ventricular coupling to study physiology and disease.

Mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction

2020 ◽  
Vol 15 (9) ◽  
pp. 1-9
Author(s):  
Kate O'Donovan
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Adverse Effects ◽  
Ejection Fraction ◽  
Mineralocorticoid Receptor ◽  
Left Ventricular ◽  
Mineralocorticoid Receptor Antagonists ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Reduced Ejection Fraction

Heart failure with reduced ejection fraction is associated with decreased functional capacity, poor quality of life and increased mortality risk. The neurohormonal compensatory response to a reduced cardiac output is mainly comprised of the sympathetic nervous system, natriuretic peptides and the renin–angiotensin–aldosterone system, which attempt to maintain peripheral perfusion. The renin–angiotensin–aldosterone system is an integral mechanism in increasing afterload by promoting angiotensin II-mediated vasoconstriction and increasing preload via the secretion of aldosterone which causes sodium and water retention. Albeit compensatory mechanisms attempt to increase cardiac output and perfusion, their effects are maladaptive as left ventricular function deteriorates in response to an increased afterload, preload and ventricular remodelling. In an attempt to interrupt this vicious circle, first-line pharmacological therapy in the treatment of heart failure is beta blockade and inhibition of the renin–angiotensin–aldosterone system. Integral to this treatment strategy are mineralocorticoid receptor antagonists, also known as aldosterone antagonists. This class of drug inhibits the action of aldosterone, decreases preload and reduces left ventricular workload, thus preserving ventricular function. This translates into reduced mortality incidence, decreased episodes of hospitalisations for cardiac causes and improvement in clinical signs and symptoms. Although patient benefits are explicit, adverse effects such as hyperkalaemia and renal impairment are associated with this therapy. Regular patient follow up and monitoring for potential adverse effects and drug interactions are essential to the success of the therapy.

scholarly journals Why are black adults over-represented among individuals who have experienced lifetime homelessness? Oaxaca-Blinder decomposition analysis of homelessness among US male adults

2020 ◽  
pp. jech-2020-214305
Author(s):  
Taeho Greg Rhee ◽  
Robert A Rosenheck
Keyword(s):  
Traumatic Events ◽  
Decomposition Analysis ◽  
White Men ◽  
Epidemiological Survey ◽  
Structural Factors ◽  
Black Adults ◽  
Black And White ◽  
Homeless Men ◽  
Younger Age ◽  
White Adults

BackgroundNon-Hispanic black adults experience homelessness at higher rates than non-Hispanic white adults in many studies. We aim to identify factors that could account for this disparity.MethodsWe used national survey data on non-Hispanic black and white men with complete data from the National Epidemiological Survey on Alcohol and Related Conditions Wave III. Using the Oaxaca-Blinder decomposition analysis, we examined race-based disparities in correlates of risk for lifetime homelessness.ResultsIn our analysis, 905 of 11 708 (7.7%) respondents, representing 6 million adults nationwide, reported lifetime homelessness. Black adults were 1.41 times more likely to have been homeless than white adults (95% CI 1.14 to 1.73; p=0.002). Overall, 81.6% of race-based inequality in lifetime homelessness were explained by three main variables with black adults having: lower incomes, greater incarceration histories since age of 18 and a greater risk of traumatic events (p<0.01 for each). They also had more antisocial personality disorder, younger age and parental drug use (p<0.05 for each).ConclusionAlthough previous studies suggested that black homeless men have higher rates of drug abuse than white homeless men, our findings highlight the fact that black–white disparities in lifetime homeless risk are associated with socio-structural factors (eg, income and incarceration) and individual adverse events (eg, traumatic events), and not associated with psychiatric or substance use disorders.

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