Aldosterone after menopause: the Study of Women's Health Across the Nation

BackgroundHypertension (HTN) is a leading risk factor for mortality and disability, often as a result of heart disease or stroke, two leading causes of death. A blood pressure rise in midlife women in industrialized societies remains poorly understood. Progressively higher aldosterone levels have been associated with proportionately higher blood pressure in some populations. We examined whether aldosterone is associated with HTN in Study of Womens Health Across the Nation (SWAN). MethodsSWAN is a longitudinal cohort of women followed from midlife into late adulthood. Analyses include 999 women free of heart failure and with serum aldosterone measured during 2015-2016 (15th follow-up) study visit (V15). HTN was defined at V15 as systolic blood pressure (SBP) or diastolic blood pressure (DBP) [&ge;]140 or [&ge;]90mmHg, respectively, or use of antihypertensive medications. Utilizing the longitudinal data available in SWAN, treatment resistant hypertension (TRH) was defined as reported use of [&ge;]4 concurrent antihypertensive medications at any visit, or [&ge;]3 concurrent antihypertensive medications and SBP[&ge;]140 or DBP[&ge;]90 at two consecutive visits. Multivariable regression related aldosterone to HTN or TRH, adjusting for age, race/ethnicity, body mass index, physical activity, smoking, and low-density lipoprotein cholesterol. ResultsAt V15, women were 66{+/-}2.7 years of age, and the prevalence of HTN and TRH was 52% and 4%, respectively. Each 1 ng/dL higher aldosterone was associated with a 4% increased odds of HTN (95%CI 1.02,1.06;p<0.001); association was not significant for TRH. ConclusionsOur findings extend growing evidence that subclinical aldosterone excess is associated with greater HTN risk in postmenopausal women.