Increased Salt-Sensitive Blood Pressure in Women vs Men: Is Relative Hyperaldosteronism the Mechanism?

Area of Science:

• Endocrinology
• Cardiovascular Physiology
• Sex Differences in Health

Background:

• Women generally exhibit higher salt-sensitive blood pressure (SSBP) and stimulated aldosterone (ALDO) levels than men.
• This suggests a potential relative hyper-aldosterone state in women contributing to their increased SSBP.

Purpose of the Study:

• To investigate whether women are in a relatively hyper-aldosterone state compared to men.
• To explore the underlying mechanisms for observed sex differences in salt sensitivity and blood pressure regulation.

Main Methods:

• Analysis of 363 women and 483 men from the HyperPATH cohort.
• Assessment of salt-sensitive blood pressure (SSBP), aldosterone (ALDO) levels, plasma renin activity (PRA), and vascular response to Angiotensin II (Ang II).
• Measurement of 24-hour urine ALDO to evaluate overall aldosterone production.

Main Results:

• Women displayed greater SSBP, ALDO, and vasculature response to Ang II, along with higher upright ALDO/PRA.
• Men had higher basal supine ALDO and PRA levels.
• Overall 24-hour urine ALDO did not differ by sex, except in specific subsets (normotensive women and women <51 years had higher urine ALDO).

Conclusions:

• Lower Ang II responsiveness in men compared to women was observed.
• Similar 24-hour urine ALDO levels in both sexes do not support a relative hyper-aldosterone state as the cause of sex differences in SSBP.
• In some cases, SSBP in women may be benign, resulting from blood pressure reduction on restricted salt diets rather than an increase on liberal salt diets.