Positive Association Between Plasma Aldosterone Concentration and White Matter Lesions in Patients With Hypertension
Background and ObjectiveWhite matter lesions (WMLs) are imaging changes in MRI of cerebral small vessel disease associated with vascular risk factors, increasing the risk of dementia, depression, and stroke. Aldosterone (ALD) or activation of mineralocorticoid receptor (MR) causes cerebrovascular in...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:14ece4170aae43fca901555d7b8dc08c2021-11-18T09:39:29ZPositive Association Between Plasma Aldosterone Concentration and White Matter Lesions in Patients With Hypertension1664-239210.3389/fendo.2021.753074https://doaj.org/article/14ece4170aae43fca901555d7b8dc08c2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fendo.2021.753074/fullhttps://doaj.org/toc/1664-2392Background and ObjectiveWhite matter lesions (WMLs) are imaging changes in MRI of cerebral small vessel disease associated with vascular risk factors, increasing the risk of dementia, depression, and stroke. Aldosterone (ALD) or activation of mineralocorticoid receptor (MR) causes cerebrovascular injury in a mouse model. We aimed to analyze the relationship between ALD and WMLs in a population with hypertension.MethodsWe conducted a retrospective review of all patients screened for causes of secondary hypertension. We enrolled 547 patients with WMLs and matched these to controls without WMLs at a 1:1 ratio. White matter lesion load was assessed by using a modified Scheltens’ scale.ResultsAmong the analytic sample (N = 1,094) with ages ranging from 30 to 64 years, 62.2% were male. We divided plasma ALD concentration (PAC), plasma renin activity (PRA), and ALD–renin ratio (ARR) into the third tertile (Q3), second tertile (Q2), and first tertile (Q1). We also analyzed them simultaneously as continuous variables. Multivariate logistic regression analysis showed that participants in Q3 (>17.26 ng/dl) of PAC (OR 1.59, 95% CI 1.15, 2.19), Q3 (<0.80 ng/dl) of PRA (OR 2.50, 95% CI 1.81, 3.44), and Q3 (>18.59 ng/dl per ng/ml*h) of ARR (OR 2.90, 95% CI 2.10, 4.01) had a significantly higher risk of WMLs than those in Q1 (<12.48) of PAC, Q1 (>2.19) of PRA, and Q1 (<6.96) of ARR. In linear regression analysis, we separately analyzed the correlation between the modified Scheltens’ scale score and log(PAC) (β = 2.36; 95% CI 1.30, 3.41; p < 0.001), log(PRA) (β = −1.76; 95% CI −2.09, −1.43; p < 0.001), and log(ARR) (β = 1.86; 95% CI 1.55, 2.17; p < 0.001), which were all significantly correlated with white matter lesion load, after adjusting for confounding factors. Simple mediation analyses showed that systolic blood pressure (SBP) or diastolic blood pressure (DBP) mediated −3.83% or −2.66% of the association between PAC and white matter lesion load, respectively. In stratified analyses, there was no evidence of subgroup heterogeneity concerning the change in the risk of WMLs (p > 0.05 for interaction for all).ConclusionHigher PAC, especially in PAC >17.26 ng/dl, increased the risk of WMLs. PAC was positively associated with white matter lesion load independent of SBP or DBP.Yujuan YuanYujuan YuanNanfang LiYan LiuQing ZhuMulalibieke HeizhatiWeiwei ZhangXiaoguang YaoDeilian ZhangQin LuoMenghui WangGuijuan ChangMei CaoKeming ZhouLei WangJunli HuNuerguli MaimaitiFrontiers Media S.A.articleplasma aldosterone concentration (PAC)white matter lesions (WMLs)hypertensioncerebral small vessel diseaseplasma renin activity (PRA)Diseases of the endocrine glands. Clinical endocrinologyRC648-665ENFrontiers in Endocrinology, Vol 12 (2021) |
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| collection |
DOAJ |
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EN |
| topic |
plasma aldosterone concentration (PAC) white matter lesions (WMLs) hypertension cerebral small vessel disease plasma renin activity (PRA) Diseases of the endocrine glands. Clinical endocrinology RC648-665 |
| spellingShingle |
plasma aldosterone concentration (PAC) white matter lesions (WMLs) hypertension cerebral small vessel disease plasma renin activity (PRA) Diseases of the endocrine glands. Clinical endocrinology RC648-665 Yujuan Yuan Yujuan Yuan Nanfang Li Yan Liu Qing Zhu Mulalibieke Heizhati Weiwei Zhang Xiaoguang Yao Deilian Zhang Qin Luo Menghui Wang Guijuan Chang Mei Cao Keming Zhou Lei Wang Junli Hu Nuerguli Maimaiti Positive Association Between Plasma Aldosterone Concentration and White Matter Lesions in Patients With Hypertension |
| description |
Background and ObjectiveWhite matter lesions (WMLs) are imaging changes in MRI of cerebral small vessel disease associated with vascular risk factors, increasing the risk of dementia, depression, and stroke. Aldosterone (ALD) or activation of mineralocorticoid receptor (MR) causes cerebrovascular injury in a mouse model. We aimed to analyze the relationship between ALD and WMLs in a population with hypertension.MethodsWe conducted a retrospective review of all patients screened for causes of secondary hypertension. We enrolled 547 patients with WMLs and matched these to controls without WMLs at a 1:1 ratio. White matter lesion load was assessed by using a modified Scheltens’ scale.ResultsAmong the analytic sample (N = 1,094) with ages ranging from 30 to 64 years, 62.2% were male. We divided plasma ALD concentration (PAC), plasma renin activity (PRA), and ALD–renin ratio (ARR) into the third tertile (Q3), second tertile (Q2), and first tertile (Q1). We also analyzed them simultaneously as continuous variables. Multivariate logistic regression analysis showed that participants in Q3 (>17.26 ng/dl) of PAC (OR 1.59, 95% CI 1.15, 2.19), Q3 (<0.80 ng/dl) of PRA (OR 2.50, 95% CI 1.81, 3.44), and Q3 (>18.59 ng/dl per ng/ml*h) of ARR (OR 2.90, 95% CI 2.10, 4.01) had a significantly higher risk of WMLs than those in Q1 (<12.48) of PAC, Q1 (>2.19) of PRA, and Q1 (<6.96) of ARR. In linear regression analysis, we separately analyzed the correlation between the modified Scheltens’ scale score and log(PAC) (β = 2.36; 95% CI 1.30, 3.41; p < 0.001), log(PRA) (β = −1.76; 95% CI −2.09, −1.43; p < 0.001), and log(ARR) (β = 1.86; 95% CI 1.55, 2.17; p < 0.001), which were all significantly correlated with white matter lesion load, after adjusting for confounding factors. Simple mediation analyses showed that systolic blood pressure (SBP) or diastolic blood pressure (DBP) mediated −3.83% or −2.66% of the association between PAC and white matter lesion load, respectively. In stratified analyses, there was no evidence of subgroup heterogeneity concerning the change in the risk of WMLs (p > 0.05 for interaction for all).ConclusionHigher PAC, especially in PAC >17.26 ng/dl, increased the risk of WMLs. PAC was positively associated with white matter lesion load independent of SBP or DBP. |
| format |
article |
| author |
Yujuan Yuan Yujuan Yuan Nanfang Li Yan Liu Qing Zhu Mulalibieke Heizhati Weiwei Zhang Xiaoguang Yao Deilian Zhang Qin Luo Menghui Wang Guijuan Chang Mei Cao Keming Zhou Lei Wang Junli Hu Nuerguli Maimaiti |
| author_facet |
Yujuan Yuan Yujuan Yuan Nanfang Li Yan Liu Qing Zhu Mulalibieke Heizhati Weiwei Zhang Xiaoguang Yao Deilian Zhang Qin Luo Menghui Wang Guijuan Chang Mei Cao Keming Zhou Lei Wang Junli Hu Nuerguli Maimaiti |
| author_sort |
Yujuan Yuan |
| title |
Positive Association Between Plasma Aldosterone Concentration and White Matter Lesions in Patients With Hypertension |
| title_short |
Positive Association Between Plasma Aldosterone Concentration and White Matter Lesions in Patients With Hypertension |
| title_full |
Positive Association Between Plasma Aldosterone Concentration and White Matter Lesions in Patients With Hypertension |
| title_fullStr |
Positive Association Between Plasma Aldosterone Concentration and White Matter Lesions in Patients With Hypertension |
| title_full_unstemmed |
Positive Association Between Plasma Aldosterone Concentration and White Matter Lesions in Patients With Hypertension |
| title_sort |
positive association between plasma aldosterone concentration and white matter lesions in patients with hypertension |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/14ece4170aae43fca901555d7b8dc08c |
| work_keys_str_mv |
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