Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection
2.3. Quantification of Components of the RAAS: Angiotensin Peptides, Aldosterone, and Equilibrium-Based Biomarkers
2.4. Statistical Analysis
3. Results
3.1. Description of the Population
3.2. Biochemical Analysis of the Serum RAAS in Pregnancy Grouped by Quartile of First Trimester Aldosterone Concentrations in Serum
3.3. Association of Declining Renin Activity over Gestation with Blood Pressure in Patients with the Highest Concentrations of Serum Aldosterone
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Parameter | Q1 | Q2 | Q3 | Q4 |
---|---|---|---|---|
n = 32 | n = 32 | n = 32 | n = 32 | |
n (%) or mean ± SD | ||||
Race | ||||
Caucasian | 25 (78.1) | 20 (62.5) | 22 (68.8) | 23 (71.9) |
Black or African American | 7 (21.9) | 4 (12.5) | 4 (12.5) | 4 (12.5) |
Hispanic | 0 | 5 (15.6) | 4 (12.5) | 3 (9.4) |
Asian | 0 | 1 (3.1) | 0 | 1 (3.1) |
Mixed race/other | 0 | 2 (6.3) | 1 (3.1) | 1 (3.1) |
Primiparous | 9 (28.1) | 10 (31.3) | 9 (28.1) | 7 (21.9) |
Previous pre-e | 7 (21.9) | 2 (6.3) | 5 (15.6) | 2 (6.3) |
Type 1 diabetes | 10 (31.3) | 5 (15.6) | 2 (6.3) | 4 (12.5) |
Type 2 diabetes | 3 (9.4) | 6 (18.8) | 9 (9.4) | 3 (9.4) |
Gestational diabetes | 4 (12.5) | 4 (12.5) | 2 (6.3) | 5 (15.6) |
Medications | ||||
Aspirin | 25 (78.1) | 21 (65.6) | 18 (56.3) | 27 (84.4) |
Labetalol or nifedipine | 4 (12.5) | 1 (3.13) | 3 (9.4) | 10 (31.3) @ |
Anti-diabetic agents | 14 (43.8) | 10 (31.3) | 7 (21.9) | 9 (28.1) |
Age, years | 27 ± 4 # | 30 ± 6 | 31 ± 7 | 30 ± 6 |
BMI, kg/m2 | 35.0 ± 10.3 | 31.4 ± 7.8 | 31.5 ± 10.3 | 34.0 ± 10.4 |
1st trimester blood pressure | ||||
SBP, mmHg | 125 ± 13 | 119 ± 13 | 120 ± 15 | 129 ± 13 * |
DBP, mmHg | 79 ± 7 | 75 ± 7 | 77 ± 9 | 82 ± 4 ** |
3rd trimester BP | ||||
SBP, mmHg | 125 ± 12 | 122 ± 14 | 120 ± 14 | 132 ± 17 ^ |
DBP, mmHg | 78 ± 6 | 76 ± 8 | 77 ± 9 | 83 ± 9 ^^ |
Gestational age at delivery, weeks | 36.8 ± 2.3 | 38.1 ± 1.7 | 38.1 ± 1.7 | 37.1 ± 2.2 |
Infant birth weight, grams | 3123 ± 711 | 3394 ± 550 | 3366 ± 559 | 3122 ± 776 |
Normotensive | 12 (37.5) | 16 (50.0) | 17 (53.1) | 7 (21.9) |
Chronic HTN | 9 (28.1) | 10 (31.3) | 7 (21.9) | 16 (50.0) @ |
Gestational HTN | 8 (25.0) | 5 (15.7) | 3 (9.4) | 6 (18.8) |
Pre-eclampsia or SPE | 3 (9.4) | 1 (3.13) | 5 (15.7) | 3 (9.4) |
Pre-term birth | 9 (28.0) | 2 (6.3) | 5 (15.6) | 7 (21.9) |
IUGR | 3 (9.4) | 0 | 0 | 4 (12.5) |
Parameter | Q1 | Q2 | Q3 | Q4 |
---|---|---|---|---|
n = 32 | n = 32 | n = 32 | n = 32 | |
Median (Interquartile Range) | ||||
Aldosterone, pmol/L | ||||
1st Trimester | 149.8 (70.58–178.2) | 279.9 (232.8–328.0) | 482.1 (416.1–612.1) | 928.6 (840.2–1194.0) # |
3rd Trimester | 437.2 (247.4–802.8) **** | 562.5 (336.8–1126) **** | 944.8 (642.6–1359) **** | 1041.0 (585.9–1742.0) # |
Angiotensin I, pmol/L | ||||
1st Trimester | 41.8 (25.3–67.6) | 69.9 (49.9–92.1) | 86.09 (59.1–125.9) | 107.0 (89.85–161.9) # |
3rd Trimester | 63.6 (45.1–131.7) *** | 95.8 (55.7–148.7) * | 121.6 (69.9–176.1) * | 108.5 (75.25–157.3) # |
Angiotensin II, pmol/L | ||||
1st Trimester | 104.3 (71.33–160.1) | 145.1 (110.9–189.4) | 172.6 (140.3–266.9) | 217.0 (169.8–350.3) # |
3rd Trimester | 107.6 (70.21–180.2) | 158.9 (90.97–281.9) | 176.0 (132.2–277.0) | 172.5 (122.8–280.6) *,# |
PRA-S, pmol/L | ||||
1st Trimester | 151.8 (101.7–225.7) | 219.1 (148.6–280.4) | 256.8 (197.8–612.1) | 326.3 (250.5–494.3) # |
3rd Trimester | 187.3 (123.2–322.8) * | 262.8 (139.5–422.9) | 292.5 (221.9–466.0) | 290.7 (205.6–456.3) # |
AA2-R, (pmol/L)/(pmol/L) | ||||
1st Trimester | 0.95 (0.71–1.62) | 1.99 (1.41–2.45) | 3.28 (2.10–4.29) | 4.63 (2.58–6.84) # |
3rd Trimester | 3.90 (2.3–7.0) **** | 3.50 (2.43–6.70) **** | 4.81 (3.20–7.72) **** | 5.25 (3.22–9.79) *,# |
Q4 (>75th Percentile) | Q1 + Q2 + Q3 (<75th Percentile) | |||
---|---|---|---|---|
ΔPRA-S < 0 n = 19 | ΔPRA-S > 0 n = 13 | ΔPRA-S < 0 n = 37 | ΔPRA-S > 0 n = 59 | |
Mean ± SD or n (%) | ||||
BMI, kg/m2 | 34.5 ± 9.2 | 33.3 ± 12.3 | 33.9 ± 11.1 | 31.8 ± 8.5 |
SBP, mmHg | 136 ± 18 # | 126 ± 12 | 126 ± 15 | 120 ± 11 |
DBP, mmHg | 85 ± 10 # | 79 ± 6 | 78 ± 7 | 76 ± 8 |
Chronic hypertension | 13 (68.4) ^ | 5 (38.5) | 14 (38) | 18 (30.5) |
Antihypertensive agents | 7 (36.8) ^ | 3 (23.1) | 5 (13.5) | 3 (5.1) |
Pre-eclampsia | 3 (15.8) | 0 | 8 (21.6) | 2 (3.4) |
Gestational hypertension | 3 (15.8) | 3 (23.1) | 8 (21.6) | 10 (16.9) |
Pre-term birth | 6 (31.6) ^ | 1 (7.7) | 10 (27.0) | 6 (16.2) |
IUGR | 3 (15.8) ^ | 1 (7.7) | 1 (2.7) | 2 (3.4) |
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Shoemaker, R.; Poglitsch, M.; Davis, D.; Huang, H.; Schadler, A.; Patel, N.; Vignes, K.; Srinivasan, A.; Cockerham, C.; Bauer, J.A.; et al. Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension. Biomedicines 2023, 11, 2954. https://doi.org/10.3390/biomedicines11112954
Shoemaker R, Poglitsch M, Davis D, Huang H, Schadler A, Patel N, Vignes K, Srinivasan A, Cockerham C, Bauer JA, et al. Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension. Biomedicines. 2023; 11(11):2954. https://doi.org/10.3390/biomedicines11112954
Chicago/Turabian StyleShoemaker, Robin, Marko Poglitsch, Dolph Davis, Hong Huang, Aric Schadler, Neil Patel, Katherine Vignes, Aarthi Srinivasan, Cynthia Cockerham, John A. Bauer, and et al. 2023. "Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension" Biomedicines 11, no. 11: 2954. https://doi.org/10.3390/biomedicines11112954
APA StyleShoemaker, R., Poglitsch, M., Davis, D., Huang, H., Schadler, A., Patel, N., Vignes, K., Srinivasan, A., Cockerham, C., Bauer, J. A., & O’Brien, J. M. (2023). Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension. Biomedicines, 11(11), 2954. https://doi.org/10.3390/biomedicines11112954