Classical and Alternative Pathways of the Renin-Angiotensin-Aldosterone System in Regulating Blood Pressure in Hypertension and Obese Adolescents

Biomedicines. 2024 Mar 10;12(3):620. doi: 10.3390/biomedicines12030620.

Abstract

Primary hypertension (PH) is the leading form of arterial hypertension (AH) in adolescents. Hypertension is most common in obese patients, where 20 to 40% of the population has elevated blood pressure. One of the most effective mechanisms for regulating blood pressure is the renin-angiotensin-aldosterone system (RAAS). The new approach to the RAAS talks about two opposing pathways between which a state of equilibrium develops. One of them is a classical pathway, which is responsible for increasing blood pressure and is represented mainly by the angiotensin II (Ang II) peptide and, to a lesser extent, by angiotensin IV (Ang IV). The alternative pathway is responsible for the decrease in blood pressure and is mainly represented by angiotensin 1-7 (Ang 1-7) and angiotensin 1-9 (Ang 1-9). Our research study aimed to assess changes in angiotensin II, angiotensin IV, angiotensin 1-7, and angiotensin 1-9 concentrations in the plasma of adolescents with hypertension, with hypertension and obesity, and obesity patients. The Ang IV concentration was lower in hypertension + obesity versus control and obesity versus control, respectively p = 0.01 and p = 0.028. The Ang 1-9 concentration was lower in the obesity group compared to the control group (p = 0.036). There were no differences in Ang II and Ang 1-7 peptide concentrations in the hypertension, hypertension and obesity, obesity, and control groups. However, differences were observed in the secondary peptides, Ang IV and Ang 1-9. In both cases, the differences were related to obesity.

Keywords: angiotensin 1–7; angiotensin 1–9; angiotensin II; angiotensin IV; arterial hypertension; obesity.