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(Hypertension. 2005;46:1316.)
© 2005 American Heart Association, Inc.

Original Articles

Body Mass Index and Angiotensin-Dependent Control of the Renal Circulation in Healthy Humans

From the Departments of Medicine (S.B.A., N.D.L.F., R.S., N.K.H.) and Radiology (N.K.H.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Sofia B. Ahmed, MD, Brigham and Women’s Hospital, 75 Francis St, PBB-3, RA-126E, Boston, MA 02115. E-mail sahmed7{at}partners.org

Obesity is increasingly recognized as a risk factor for renal disease, but the mechanism is unclear. Renal plasma flow response to captopril, as an index of renin-angiotensin system activity, was measured by para-aminohippurate clearance technique in 100 healthy, normotensive subjects in balance on a high-salt diet. Of the 100 subjects, body mass index exceeded 25 in 56 and exceeded 30 in 22. The average vasodilator response to captopril was 27±7 mL/min per 1.73 m² (P<0.0001). After adjustment for other predictors of the renal plasma flow response to captopril using a multivariate linear regression model, there was a highly significant relationship between age- and plasma renin activity–adjusted body mass index and the renal plasma flow response to captopril; however, a quadratic model provided a substantially better fit (r=0.55; P<0.0001; P=0.03 versus linear correlation). The strong association between increasing body mass index and angiotensin-dependent control of the renal circulation suggests that this may be a mechanism by which obesity contributes to renal disease. Weight loss should be considered in the overweight or obese patient for renal protection.

Key Words: obesity • hemodynamics • body mass index • renin-angiotensin system • angiotensin II • kidney

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