The relation of hypertension and aldosterone-renin ratio with the severity of coronary artery disease in non-diabetic patients

Document Type: Original Article

Authors

1 Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran

2 Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences and Department of Biochemistry, Afzalipur Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran

3 Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Background: The aim of this study was to assess the relationship between hypertension and aldosterone-renin ratio (ARR) with the severity of coronary artery disease (CAD).
Methods: This cross-sectional study was performed on non-diabetic patients who were candidate for coronary angiography in Shafa hospital in Kerman in 2017. The levels of active renin and aldosterone were measured by the radioimmunoassay (RIA) method before angiography. All patients underwent coronary angiography to determine the severity of CAD. The CAD severity was described by the Gensini score.
Results: Of the 306 patients, 174 (55.1%) were hypertensive. The overall prevalence of CAD in hypertensive and normotensive groups was not statistically different (39.7% versus 38.9%, p = 0.898). In groups with and without hypertension, normal coronary arteries were found in 60.3% and 60.8%, single-vessel disease in 15.5% and 17.7%, two-vessel disease in 14.4% and 11.5%, and three-vessel disease in 9.8% and 10.0%, respectively. The differences were not significant (p = 0.880). The average Gensini scores in hypertensive and normotensive groups were 29.27 ± 28.42 and 33.74 ± 33.05, respectively with no significant differences (p = 0.370). The mean ARR in those with normal coronaries, one, two, and three-vessel diseases was 3.17 ± 7.63, 2.51 ± 4.21, 1.93 ±1.57, and 1.20 ± 0.68, respectively with no significant difference (p = 0.696). We did not observe any association between the Gensini score and ARR (r = -0.126, p = 0.263). In multivariable linear regression model (Table 3), ARR could not predict the severity of CAD assessed by determining the Gensini score (Beta = -0.463, p = 0.636).
Conclusion: There was no significant relation between hypertension and ARR to the severity of CAD.

Keywords


  1. Gaziano JM. Global burden of cardiovascular disease. In: Zipes DP, Libby P, Bonow RO, Braunwald E, editors. Braunwald's Heart Disease. 7th ed. Philadelphia: Elsevier Saunders; 2005. p. 423-55.
  2. Bossone, E., et al., Presenting systolic blood pressure and outcomes in patients with acute aortic dissection. Journal of the American College of Cardiology, 2018. 71(13): p. 1432-1440
  3. Ecological analysis of the association between mortality and major risk factors of cardiovascular disease. The Word Health Organization MONICA Project.Int J Epidemiol. 1994; 23(3).505-516.
  4. Nelson, R., Hyperlipidemia as a Risk Factor for Cardiovascular Disease Robert. Prim Care, 2014. 40(1): p. 195-211.
  5. Sun D, Cao J. Liu X, Yu L. Yao C et al. Combined effect of smoking systolic blood pressure on risk of coronary heart disease: a chohort study in Chinese women. J WomensHealth (larchmt) 2010 Mar 4. [Epub ahead of print].
  6. Lonn, E.M., et al., Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. New England Journal of Medicine, 2016. 374(21): p. 2009-2020.7.
  7. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M., et al., Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation, 2017. 135(10): p. e146.
  8. Solomon, S.D., et al., Effect of angiotensin receptor blockade and antihypertensive drugs on diastolic function in patients with hypertension and diastolic dysfunction: a randomised trial. The Lancet, 2007. 369(9579): p. 2079-2087.
  9. Damay, V., et al., The Significance of Hypertension Towards the Number of Vessel Involvement in Cad Patients Undergoing Coronary Angiography. Journal of Hypertension, 2015. 33: p. e32.
  10. Larifla, L., et al., Distribution of coronary artery disease severity and risk factors in Afro-Caribbeans. Archives of cardiovascular diseases, 2014. 107(4): p. 212-218.
  11. Baguet JP, Barone-Rochette G, Mallion JM. European society of hypertension scientific newsletter: hypertension and coronary heart disease. J Hypertens 2006; 24(11): 2323-5.
  12. Duprez, D.A., Role of the renin–angiotensin–aldosterone system in vascular remodeling and inflammation: a clinical review. Journal of hypertension, 2006. 24(6): p. 983-991.
  13. Calhoun, D.A., Aldosterone and cardiovascular disease: smoke and fire. 2006, Am Heart Assoc
  14. VieraAJ, Neutze DM. Diagnosis of secondary hypertension: an age-based approach. American family physician December 15, 2010; 82: 1471-8.
  15. 15.Clark III, D., M.I. Ahmed, and D.A. Calhoun, Resistant hypertension and aldosterone: an update. Canadian Journal of Cardiology, 2012. 28(3): p. 318-325.
  16. Rosendorff, C. and W. Committee, Hypertension and coronary artery disease: a summary of the American Heart Association scientific statement. The Journal of Clinical Hypertension, 2007. 9(10): p. 790-795.
  17. Leon BM1, Maddox TM1 Diabetes and cardiovascular disease: Epidemiology, biologicalmechanisms, treatment recommendations and future research. World J Diabetes. 2015 Oct 10; 6(13):1246-58. doi: 10.4239/wjd.v6.i13.1246.
  18. Bhandari SK1, Batech M2, Shi J2, Jacobsen SJ2, Sim JJ1. Plasma renin activity and risk of cardiovascular and mortality outcomes among individuals with elevated and nonelevatedblood pressure. Kidney Res Clin Pract. 2016 Dec; 35(4):219-228. Epub 2016 Jul 26.
  19. Erne, P., et al., Aldosterone and renin in cardiac patients referred for catheterization. Medicine, 2017. 96(25).
  20. Ali, I.A., et al., Pattern of presentation of coronary artery disease in hypertensive patients. Sudan Journal of Medical Sciences, 2012. 7(1).