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Blood Levels of Angiotensinogen and Hypertension
Quick Takes
- Females of all race/ethnic groups had higher median angiotensinogen levels than males.
- Higher levels of angiotensinogen were associated with higher BP and higher odds of prevalent hypertension.
- Additional studies are needed to assess genetic determinants of angiotensinogen concentration and the effect of sex hormones on the relationship of angiotensin to BP.
Study Questions:
What is the relationship of circulating angiotensinogen levels to ethnicity, sex, blood pressure (BP), incident hypertension, and prevalent hypertension in a modern sex-balanced ethnically diverse cohort?
Methods:
The investigators measured plasma angiotensinogen levels in 5,786 participants from MESA (Multiethnic Study of Atherosclerosis). Linear, logistic, and Cox proportional hazards models were utilized to examine the associations of angiotensinogen with BP, prevalent hypertension, and incident hypertension, respectively.
Results:
Angiotensinogen levels were significantly higher in females than males and differed across self-reported ethnicities with the ordering (from highest to lowest): White, Black, Hispanic, and Chinese adults. Higher levels were associated with higher BP and odds of prevalent hypertension, after adjusting for other risk factors. Equivalent relative differences in angiotensinogen were associated with greater differences in BP in males versus females. In males not taking renin-angiotensin-aldosterone system (RAAS)-blocking medications, a standard deviation increment in log-angiotensinogen was associated with 2.61 mm Hg higher systolic BP (95% confidence interval [CI], 1.49-3.80), while in females, the same increment in angiotensinogen was associated with 0.97 mm Hg higher systolic BP (95% CI, 0.30-1.65).
Conclusions:
The authors report that a positive association is present between levels and prevalent hypertension and BP, which differs between sexes.
Perspective:
This analysis reports that females had higher median angiotensinogen levels than males and that higher levels were associated with higher BP and higher odds of hypertension. Despite males having lower levels on average than females, the association between angiotensinogen and BP was more positive in males, which may be attributable to sex differences in the metabolism of angiotensinogen and in the expression of receptors for Ang peptides. Ethnicity-associated variation in angiotensinogen levels is also present, with White participants having highest levels compared to Black, Hispanic, and Chinese participants. Additional studies are indicated to assess the genetic determinants of angiotensinogen concentration and the effect of sex hormones on the relationship of angiotensin to BP.
Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Genetic Arrhythmic Conditions, Lipid Metabolism, Novel Agents, Hypertension
Keywords: Aldosterone, Angiotensinogen, Angiotensins, Atherosclerosis, Blood Pressure, Ethnic Groups, Genetics, Hypertension, Primary Prevention, Renin, Renin-Angiotensin System, Sex Characteristics, Vascular Diseases
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