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Aldosterone and angiotensin II profiles in young black and white women using different hormonal contraceptives: the African-PREDICT study

Journal of Human Hypertension volume 36, pages 711–717 (2022)Cite this article

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Abstract

Exogenous estrogens and progestins may affect the components of the renin–angiotensin–aldosterone system (RAAS). Changes in ventricular blood volume are associated with increased secretion of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP), which may also be affected by hormonal contraceptives. In this study, we aimed to compare components of the RAAS and NT-proBNP between groups using different hormonal contraceptives, including the combination pill, the injection or implant, and controls (no contraception) in black and white women of fertile age (20 – 30 years). Secondly, we determined whether blood pressure and NT-proBNP are associated with the RAAS components. We included 397 black and white women not using contraceptives, 120 using the combination pill, and 103 receiving an injection/implant. RAAS Triple-A analysis was carried out with LC-MS/MS quantification, and blood pressure measurements (ABPM) taken over 24 h. We found that serum aldosterone was higher (475.7 vs. 249.2 pmol/L; p < 0.001) in the combination pill group than in the no contraception group of white women. The aldosterone-angiotensin II ratio (AA2) was higher (5.4 vs. 2.5; p < 0.001) in the combination pill group than in the no contraception group. In the black women using the combination pill, we found a borderline-positive and borderline-negative association between 24-h systolic blood pressure and NT-proBNP with equilibrium (eq) Ang II, respectively. In white women using the combination pill, only CRP contributed positively and independently to NT-proBNP. To conclude, activation of RAAS by different hormonal contraceptives may increase future risk for the development of hypertension in young black and white women.

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Acknowledgements

We thank the participants in this substudy, as well as the staff who participated in collecting the data.

Funding

This work is supported by the South African Medical Research Council (SAMRC) with funds from the National Treasury under its Economic Competitiveness and Support Package; the South African Research Chairs Initiative (SARChI) of the Department of Science and Technology and National Research Foundation (NRF) of South Africa; the SAMRC with funds received from the South African National Department of Health, GlaxoSmithKline R&D (Africa Non-Communicable Disease Open Lab grant); the UK Medical Research Council and with funds from the UK Government’s Newton Fund; as well as the corporate social investment grants from Pfizer (South Africa); Boehringer Ingelheim (South Africa); Novartis (South Africa); the MediClinic Hospital Group (South Africa); and in-kind contributions from Roche Diagnostics (South Africa). Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors, and therefore, the National Research Foundation (NRF) does not accept any liability in this regard.

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Authors and Affiliations

  1. Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa

    Johannes M. van Rooyen, Catharina M. C. Mels, Hugo W. Huisman, Lebo F. Gafane-Matemane, Shani Le Roux, Leandi Lammertyn, Yolandi Breet, Lisa Uys & Aletta E. Schutte

  2. South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa

    Johannes M. van Rooyen, Catharina M. C. Mels, Hugo W. Huisman, Lebo F. Gafane-Matemane, Shani Le Roux, Leandi Lammertyn, Yolandi Breet, Lisa Uys & Aletta E. Schutte

  3. Attoquant Diagnostics, Vienna, Austria

    Marko Poglitsch

  4. School of Population Health, The University of New South Wales; The George Institute for Global Health, Sydney NWS, Australia

    Aletta E. Schutte

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  1. Johannes M. van Rooyen
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Correspondence to Johannes M. van Rooyen.

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Dr M Poglitsch has stocks in Attoquant Diagnostics GmbH.

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van Rooyen, J.M., Poglitsch, M., Mels, C.M.C. et al. Aldosterone and angiotensin II profiles in young black and white women using different hormonal contraceptives: the African-PREDICT study. J Hum Hypertens 36, 711–717 (2022). https://doi.org/10.1038/s41371-021-00569-6

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