Elsevier

The Journal of Pediatrics

Volume 163, Issue 5, November 2013, Pages 1317-1322.e1
The Journal of Pediatrics

Original Article
Adiposity Has Unique Influence on the Renin-Aldosterone Axis and Blood Pressure in Black Children

https://doi.org/10.1016/j.jpeds.2013.06.082Get rights and content

Objective

To comparatively examine the effects of adiposity on the levels of plasma renin activity (PRA), plasma aldosterone concentration (PAC), and aldosterone-renin ratio (ARR) in young black and white children.

Study design

We prospectively assessed 248 black and 345 white children and adolescents. A novel analytical technique was used to assess the concurrent influences of age and body mass index (BMI) on PRA, PAC, and ARR. The estimated effects were depicted by colored contour plots.

Results

In contrast to whites, blacks had lower PRA (2.76 vs 3.36 ng/mL/h; P < .001) and lower PAC (9.01 vs 14.59 ng/dL; P < .001). In blacks, BMI was negatively associated with PRA (P = .001), consistent with an association with a more expanded plasma volume; there was no association with PAC. In whites, BMI was positively associated with PAC (P = .005); we did not detect a BMI-PRA association. The effects of BMI on ARR were directionally similar in the two race groups but more pronounced in blacks. Mean systolic blood pressure was greater in blacks with lower PRA (P < .01), higher PAC (P = .015), and higher ARR (P = .49).

Conclusions

An increase in adiposity was associated with a suppressed PRA in blacks and an increase in PAC in whites. The unique relationship between adiposity and renin-aldosterone axis in blacks suggests the possible existence of a population-specific mechanism characterized by volume expansion, which could in turn enhance the influences of adiposity on blood pressure in black children and adolescents.

Section snippets

Methods

The study design and data collection process were previously described.11, 12 Briefly, subjects were healthy black and white young people recruited from 33 participating schools in Indianapolis. The schools were selected to provide a range in socioeconomic status. Those with a history of cardiac and kidney disease, hypertension, diabetes mellitus, and those taking medications that can affect BP were excluded. Although subjects were followed prospectively with measurements of BP, height, and

Results

Five hundred ninety-three subjects contributed a total of 728 visits where blood samples were collected. Of these, 134 subjects contributed multiple blood samples during the course of follow-up. Demographic and clinical characteristics of the study subjects are presented in Table I. For continuous variable we reported mean values and 95% CI estimates. On average, blacks were slightly younger than whites (14.21 vs 15.10 years; P < .001), and had greater BMI (24.41 vs 22, P < .001), greater

Discussion

Obesity, which has taken on an alarmingly high prevalence and more so in blacks than in whites,16, 17 is a major contributor to the risk for hypertension.18, 19 Previous studies in adolescents as well as in adults have shown that levels of adiposity can be accompanied by increases in aldosterone production.6, 7, 20, 21 In the present study, we also found that PAC increased with BMI, but only in white subjects (Figure 1, A). In black subjects, on the other hand, there was little evidence that

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    Funded by the National Institutes of Health (RO1 HL095086) and a Veterans Administration Merit Review Award. The authors declare no conflicts of interest.

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