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Comparative Study
. 2016 Jul;68(1):195-203.
doi: 10.1161/HYPERTENSIONAHA.116.07289. Epub 2016 May 9.

Hemodynamics and Salt-and-Water Balance Link Sodium Storage and Vascular Dysfunction in Salt-Sensitive Subjects

Affiliations
Comparative Study

Hemodynamics and Salt-and-Water Balance Link Sodium Storage and Vascular Dysfunction in Salt-Sensitive Subjects

Cheryl L Laffer et al. Hypertension. 2016 Jul.

Abstract

We investigated 24-hour hemodynamic changes produced by salt loading and depletion in 8 salt-sensitive (SS) and 13 salt-resistant (SR) normotensive volunteers. After salt loading, mean arterial pressure was higher in SS (96.5±2.8) than in SR (84.2±2.7 mm Hg), P<0.01, owing to higher total peripheral resistance in SS (1791±148) than in SR (1549±66 dyn*cm(-5)*s), P=0.05, whereas cardiac output was not different between groups (SS 4.5±0.3 versus SR 4.4±0.2 L/min, not significant). Following salt depletion, cardiac output was equally reduced in both groups. Total peripheral resistance increased 24±6% (P<0.001) in SR, whose mean arterial pressure remained unchanged. In contrast, total peripheral resistance did not change in SS (1±6%, not significant). Thus, their mean arterial pressure was reduced, abolishing the mean arterial pressure difference between groups. SS had higher E/e' ratios than SR in both phases of the protocol. In these 21 subjects and in 32 hypertensive patients, Na(+) balance was similar in SR and SS during salt loading or depletion. However, SR did not gain weight during salt retention (-158±250 g), whereas SS did (819±204), commensurate to iso-osmolar water retention. During salt depletion, SR lost the expected amount of weight for iso-osmolar Na(+) excretion, whereas SS lost a greater amount that failed to fully correct the fluid retention from the previous day. We conclude that SS are unable to modulate total peripheral resistance in response to salt depletion, mirroring their inability to vasodilate in response to salt loading. We suggest that differences in water balance between SS and SR indicate differences in salt-and-water storage in the interstitial compartment that may relate to vascular dysfunction in SS.

Keywords: blood pressure; body water; hemodynamics; sodium.

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Figures

Fig 1
Fig 1
The columns show data in all SR (white fill) or SS (black fill) subjects analyzed together. The small symbols with dashed error lines that surround each column show the same data in the respective normotensive (squares) or hypertensive (triangles) subgroups of each group. The leftmost columns of both panels shows the amount of sodium retained during the sodium loading day of the experiment (see text). The middle columns show the estimated (Est) amount of weight gain to retain the sodium in isoosmolar manner. The right columns show the actual observed (Obs) weight change in the two groups of patients. Symbols inside the black columns are for the difference for each parameter between the SS and SR groups. ns, not significant; *, p<0.001.
Fig 2
Fig 2
The columns show data in all SR (white fill) or SS (black fill) subjects analyzed together. The small symbols with dashed error lines that surround each column show the same data in the respective normotensive (squares) or hypertensive (triangles) subgroups of each group. The leftmost columns of both panels shows the amount of sodium lost during the sodium depleting day of the experiment (see text). The middle columns show the estimated (Est) amount of weight loss needed to lose the sodium with isoosmolar water. The right columns show the actual observed (Obs) weight change in the two groups of patients. Symbols inside the black columns are for the difference for each parameter between the SS and SR groups. ns, not significant; †, p~0.06. Brackets are for the comparison of expected vs actual weight loss in the SR and in the SS subjects.
Fig 3
Fig 3
Hemodynamic parameters in 13 salt resistant (SR, open columns) and 8 salt sensitive (SS, black columns) normotensive volunteers. Data after the second day of the experiment are presented first, to emphasize that there were no hemodynamic differences between the groups after salt depletion. MAP, mean arterial pressure at the time of the echocardiograms; CO, cardiac output; TPR, total peripheral resistance; E/e’, the ratio between the E velocity of mitral inflow and the tissue Doppler e annular velocity; LoNa, the day of salt depletion; HiNa, the day of salt loading. Statistics given within the black columns are for the comparison of each parameter between SS and SR on the same day. Statistics given in the small brackets between columns are for the paired deltas of the parameters between LoNa and HiNa days, either within the SR or within the SS groups. Statistics given in the large brackets between pairs of columns are for the unpaired differences between the deltas in the SR and SS groups. ns, not significant.
Fig 4
Fig 4
Relationships of the magnitude of SSBP; i.e., the difference in systolic BP between the low salt and high salt days of the experiment, (ΔSBP LoNa – HiNa, mmHg) with the change in TPR from LoNa to HiNa (left panel, ΔTPR LoNa-HiNa, dyn*cm-5*sec-1) or with the ratio between the E velocity of mitral inflow and the tissue Doppler e annular velocity on the HiNa day (right panel, E/e’ ratio HiNa). Black and white circles represent SS and SR subjects, respectively. Correlation coefficients, the regression lines and the statistical significance are for the 21 normotensive volunteers analyzed altogether.

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