Journal of Human Hypertension (2014), 1 & 2014 Macmillan Publishers Limited All rights reserved 0950-9240/14 www.nature.com/jhh
LETTER TO THE EDITOR
Adipokines: another link between obesity and hypertension Journal of Human Hypertension advance online publication, 17 April 2014; doi:10.1038/jhh.2014.28
We have read the interesting review entitled ‘A critical review of the evidence supporting aldosterone in the etiology and its blockade in the treatment of obesity-associated hypertension’.1 This article reviews with great background concepts about obesity, aldosterone and hypertension. However, there is no mention about adipokines—bioactive mediators produced by adipose tissue2—and its association in the link obesity/hypertension.3–5 As we know, higher aldosterone levels in obese subjects may be relevant as a complicating factor for the lack of blood pressure (BP) control3,6 and as a mediator of maladaptive changes associated with cardiovascular abnormalities.3 Lipid factors seem to stimulate aldosterone secretion4 in mineralocorticoid receptor on adipose tissue, which in turn activates proinflammatory adipokine expression.5 Those conditions may contribute to mechanisms related to the development of resistant hypertension (RHTN). Our group had recently described the influence of these adipokines in RHTN subgroups showing that adipocyte substrates are associated with overweight and obese hypertensive population. Uncontrolled resistant hypertensive (UCRHTN) subgroup presented higher leptin and resistin levels, whereas adiponectin levels were lower.7 Also, adiponectin and leptin were associated with pulse pressure8 and with systolic and diastolic BP respectively, and with plasma aldosterone levels (PAC) in UCRHTN.9 Taken together, we concluded that deregulation of adipokine levels may contribute to the lack of BP control leading to a condition of increased resistance to antihypertensive treatment and also increased cardiovascular risk. The authors well pointed out the adipocyte influence in aldosterone production and the role of mineralocorticoids in individuals with obesity-associated hypertension. Adding to that, we recognize the importance of adipokines contributing to hypertension and cardiovascular alterations.
CONFLICT OF INTEREST The authors declare no conflict of interest.
AR Sabbatini, APC de Faria, R Modolo and H Moreno Department of Pharmacology, Faculty of Medical Sciences University of Campinas—UNICAMP, Campinas, Brazil E-mail: [email protected] REFERENCES 1 Byrd JB, Brook RD. A critical review of the evidence supporting aldosterone in the etiology and its blockade in the treatment of obesity-associated hypertension. J Hum Hypertens 2014; 28: 3–9. 2 Fonseca-Alaniz MH, Takada J, Alonso-Vale MILima FB. Adipose tissue as an endocrine organ: from theory to practice. J Pediatr (Rio J) 2007; 83: S192–S203. 3 Sowers JR, Whaley-Connell A, Epstein M. Narrative review: the emerging clinical implications of the role of aldosterone in the metabolic syndrome and resistant hypertension. Ann Intern Med 2009; 150: 776–783. 4 Caprio M, Feve B, Claes A, Viengchareun S, Lombes MZennaro MC. Pivotal role of the mineralocorticoid receptor in corticosteroid-induced adipogenesis. FASEB J 2007; 21: 2185–2194. 5 Ehrhart-Bornstein M, Arakelyan K, Krug AW, Scherbaum WABornstein SR. Fat cells may be the obesity-hypertension link: human adipogenic factors stimulate aldosterone secretion from adrenocortical cells. Endocr Res 2004; 30: 865–870. 6 Martins LC, Figueiredo VN, Quinaglia T, Boer-Martins L, Yugar-Toledo JC, Martin JF et al. Characteristics of resistant hypertension: ageing, body mass index, hyperaldosteronism, cardiac hypertrophy and vascular stiffness. J Hum Hypertens 2011; 25: 532–538. 7 Sabbatini AR, Faria AP, Barbaro NR, Gordo WM, Modolo RGP, Pinho C et al. Deregulation of adipokines related to target organ damage on resistant hypertension. J Hum Hypertens (e-pub ahead of print 28 November 2013 doi:10.1038/ jhh.2013.118). 8 de Faria AP, Demacq C, Figueiredo VN, Moraes CH, Santos RC, Sabbatini AR et al. Hypoadiponectinemia and aldosterone excess are associated with lack of blood pressure control in subjects with resistant hypertension. Hypertens Res 2013; 36(12): 1067–1072. 9 de Haro Moraes C, Figueiredo VN, de Faria AP, Barbaro NR, Sabbatini AR, Quinaglia T et al. High-circulating leptin levels are associated with increased blood pressure in uncontrolled resistant hypertension. J Hum Hypertens 2013; 27: 225–230.
LETTER TO THE EDITOR
Adipokines: another link between obesity and hypertension Journal of Human Hypertension advance online publication, 17 April 2014; doi:10.1038/jhh.2014.28
We have read the interesting review entitled ‘A critical review of the evidence supporting aldosterone in the etiology and its blockade in the treatment of obesity-associated hypertension’.1 This article reviews with great background concepts about obesity, aldosterone and hypertension. However, there is no mention about adipokines—bioactive mediators produced by adipose tissue2—and its association in the link obesity/hypertension.3–5 As we know, higher aldosterone levels in obese subjects may be relevant as a complicating factor for the lack of blood pressure (BP) control3,6 and as a mediator of maladaptive changes associated with cardiovascular abnormalities.3 Lipid factors seem to stimulate aldosterone secretion4 in mineralocorticoid receptor on adipose tissue, which in turn activates proinflammatory adipokine expression.5 Those conditions may contribute to mechanisms related to the development of resistant hypertension (RHTN). Our group had recently described the influence of these adipokines in RHTN subgroups showing that adipocyte substrates are associated with overweight and obese hypertensive population. Uncontrolled resistant hypertensive (UCRHTN) subgroup presented higher leptin and resistin levels, whereas adiponectin levels were lower.7 Also, adiponectin and leptin were associated with pulse pressure8 and with systolic and diastolic BP respectively, and with plasma aldosterone levels (PAC) in UCRHTN.9 Taken together, we concluded that deregulation of adipokine levels may contribute to the lack of BP control leading to a condition of increased resistance to antihypertensive treatment and also increased cardiovascular risk. The authors well pointed out the adipocyte influence in aldosterone production and the role of mineralocorticoids in individuals with obesity-associated hypertension. Adding to that, we recognize the importance of adipokines contributing to hypertension and cardiovascular alterations.
CONFLICT OF INTEREST The authors declare no conflict of interest.
AR Sabbatini, APC de Faria, R Modolo and H Moreno Department of Pharmacology, Faculty of Medical Sciences University of Campinas—UNICAMP, Campinas, Brazil E-mail: [email protected] REFERENCES 1 Byrd JB, Brook RD. A critical review of the evidence supporting aldosterone in the etiology and its blockade in the treatment of obesity-associated hypertension. J Hum Hypertens 2014; 28: 3–9. 2 Fonseca-Alaniz MH, Takada J, Alonso-Vale MILima FB. Adipose tissue as an endocrine organ: from theory to practice. J Pediatr (Rio J) 2007; 83: S192–S203. 3 Sowers JR, Whaley-Connell A, Epstein M. Narrative review: the emerging clinical implications of the role of aldosterone in the metabolic syndrome and resistant hypertension. Ann Intern Med 2009; 150: 776–783. 4 Caprio M, Feve B, Claes A, Viengchareun S, Lombes MZennaro MC. Pivotal role of the mineralocorticoid receptor in corticosteroid-induced adipogenesis. FASEB J 2007; 21: 2185–2194. 5 Ehrhart-Bornstein M, Arakelyan K, Krug AW, Scherbaum WABornstein SR. Fat cells may be the obesity-hypertension link: human adipogenic factors stimulate aldosterone secretion from adrenocortical cells. Endocr Res 2004; 30: 865–870. 6 Martins LC, Figueiredo VN, Quinaglia T, Boer-Martins L, Yugar-Toledo JC, Martin JF et al. Characteristics of resistant hypertension: ageing, body mass index, hyperaldosteronism, cardiac hypertrophy and vascular stiffness. J Hum Hypertens 2011; 25: 532–538. 7 Sabbatini AR, Faria AP, Barbaro NR, Gordo WM, Modolo RGP, Pinho C et al. Deregulation of adipokines related to target organ damage on resistant hypertension. J Hum Hypertens (e-pub ahead of print 28 November 2013 doi:10.1038/ jhh.2013.118). 8 de Faria AP, Demacq C, Figueiredo VN, Moraes CH, Santos RC, Sabbatini AR et al. Hypoadiponectinemia and aldosterone excess are associated with lack of blood pressure control in subjects with resistant hypertension. Hypertens Res 2013; 36(12): 1067–1072. 9 de Haro Moraes C, Figueiredo VN, de Faria AP, Barbaro NR, Sabbatini AR, Quinaglia T et al. High-circulating leptin levels are associated with increased blood pressure in uncontrolled resistant hypertension. J Hum Hypertens 2013; 27: 225–230.
