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Obese Hypertensive Men Have Lower Circulating Proatrial Natriuretic Peptide Concentrations Despite Greater Left
Camilla L Asferg1, Ulrik B Andersen1, Allan Linneberg2,3,4
1Department of Clinical Physiology, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark.
Insights
Obese hypertensive men exhibit lower midregional proatrial natriuretic peptide (MR-proANP) levels despite increased left atrial size. This finding suggests a natriuretic handicap may contribute to obesity-related hypertension.
Area of Science:
- Cardiology
- Endocrinology
- Hypertension Research
Background:
- Obesity is linked to lower natriuretic peptide (NP) concentrations, potentially contributing to hypertension.
- Hypertension with left atrial enlargement typically shows higher NP levels.
- The relationship between obesity, hypertension, and NP in the context of left atrial size requires clarification.
Purpose of the Study:
- To investigate if obese hypertensive men have reduced circulating NP concentrations despite increased left atrial size.
- To explore the role of natriuretic peptides in obesity-related hypertension.
Main Methods:
- Studied 98 obese men and 27 lean normotensive men, all healthy and medication-free.
- Measured 24-hour ambulatory blood pressure (ABP) to define hypertension (≥ 130/80 mm Hg).
- Assessed left atrial size via echocardiography and measured serum midregional proatrial NP (MR-proANP).
Main Results:
- Obese hypertensive men had significantly larger left atrial size compared to lean normotensive and obese normotensive men (P < 0.01).
- Despite larger left atrial size, obese hypertensive men showed lower MR-proANP concentrations (median 48.5 pmol/l) than lean normotensive men (median 69.3 pmol/l) (P < 0.01).
- Obese normotensive men had intermediate MR-proANP levels.
Conclusions:
- Obese hypertensive men present with lower circulating MR-proANP concentrations, even with evidence of pressure-induced left atrial enlargement.
- This suggests a potential 'natriuretic handicap' in obese hypertensive individuals.
- Further research is needed to elucidate the mechanisms behind this phenomenon and its clinical implications.
Background:
Obese persons have lower circulating natriuretic peptide (NP) concentrations. It has been proposed that this natriuretic handicap plays a role in obesity-related hypertension. In contrast, hypertensive patients with left atrial enlargement have higher circulating NP concentrations. On this background, we investigated whether obese hypertensive men could have lower circulating NP concentrations despite evidence of pressure-induced greater left atrial size.
Methods:
We examined 98 obese men (body mass index [BMI] ≥ 30.0 kg/m2) and 27 lean normotensive men (BMI 20.0-24.9 kg/m2). All men were healthy, medication free, with normal left ventricular ejection fraction. We measured blood pressure using 24-hour ambulatory blood pressure (ABP) recordings. Hypertension was defined as 24-hour ABP ≥ 130/80 mm Hg, and normotension was defined as 24-hour ABP < 130/80 mm Hg. We determined left atrial size using echocardiography, and we measured fasting serum concentrations of midregional proatrial NP (MR-proANP).
Results:
Of the 98 obese men, 62 had hypertension and 36 were normotensive. The obese hypertensive men had greater left atrial size (mean ± SD: 28.7 ± 6.0 ml/m2) compared with the lean normotensive men (23.5 ± 4.5 ml/m2) and the obese normotensive men (22.7 ± 5.1 ml/m2), P < 0.01. Nevertheless, despite evidence of pressure-induced greater left atrial size, the obese hypertensive men had lower serum MR-proANP concentrations (median [interquartile range]: 48.5 [37.0-64.7] pmol/l) compared with the lean normotensive men (69.3 [54.3-82.9] pmol/l), P < 0.01, whereas the obese normotensive men had serum MR-proANP concentrations in between the 2 other groups (54.1 [43.6-62.9] pmol/l).
Conclusions:
Despite greater left atrial size, obese hypertensive men have lower circulating MR-proANP concentrations compared with lean normotensive men.
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