Advertisement

Abnormal renal sodium handling in essential hypertension

Relation to failure of renal and adrenal modulation of responses to angiotensin II
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      A continuing medical education quiz on this article (one hour of Category 1 credit) appears on page A125 of this issue. This study assessed renal sodium handling in a group of patients with essential hypertension in whom control of the renal blood supply and aldosterone release by angiotensin II is abnormal (“non-modulating”) because of recent evidence that these patients have sodium-sensitive hypertension. Sixty-one patients were studied, 25 as balance was achieved with a daily sodium intake of 10 meq and 36 after a shift from a 10 meq to 200 meq sodium intake for five days. Renal and adrenal responsiveness to angiotensin II was assessed by measurement of para-aminohippurate clearance and plasma aldosterone prior to and during the infusion of 3 ng/kg per minute of angiotensin II, to identify the non-modulator group (n = 32). The half-time of the exponential function relating sodium excretion to time during the three to five days when external balance was being achieved with a 10 meq sodium intake was 23.9 ± 0.3 hours in 60 normal subjects, 24.5 ± 1.8 hours in the patients with essential hypertension in whom renal responsiveness to angiotensin II was normal, and prolonged (p <0.001) to 36.6 ± 2.1 hours in the non-modulating patients. A prolonged half-time suggests that, with a shift to a high sodium intake, more time will be required to achieve external sodium balance and at the expense of more retained sodium. During the shift from a 10 to 200 meq sodium intake, the non-modulator group showed a delayed rate at which external sodium balance was achieved, greater cumulative positive sodium balance, more weight gain, and a greater frequency of blood pressure rise. The abnormality in the rate at which external sodium balance is achieved in non-modulation results in a difference in total body sodium that varies with sodium intake and that may well contribute to, or cause, sodium-sensitive hypertension.
      To read this article in full you will need to make a payment

      References

        • Dahl LK
        Salt and hypertension.
        Am J Clin Nutr. 1972; 25: 231-234
        • Freis ED
        Salt, volume and the prevention of hypertension.
        Circulation. 1976; 53: 589-594
        • Tobian L
        How sodium and the kidney relate to the hypertensive arteriole.
        Fed Proc. 1974; 33: 138-142
        • Dahl LK
        • Heine M
        Primary role of renal homografts in setting chronic blood pressure levels in rats.
        Circ Res. 1975; 36: 692-696
        • Fujita T
        • Henry WL
        • Bartter FC
        • Lake CR
        • Delea CS
        Factors influencing blood pressure in salt-sensitive patients with hypertension.
        Am J Med. 1980; 69: 334-344
        • Burg MB
        Renal handling of sodium, chloride, water, amino acids, and glucose.
        in: 2nd ed. The kidney. vol 1. WB Saunders, Philadelphia1981: 272-298
        • Dirks J
        • Seely JF
        • Levy M
        Control of extracellular fluid volume.
        in: 2nd ed. The kidney. vol 1. WB Saunders, Philadelphia1981: 495-552
        • Hollenberg NK
        • Merrill JP
        Intrarenal perfusion in the young “essential” hypertensive: a subpopulation resistant to sodium restriction.
        Trans Assoc Am Physicians. 1970; 83: 93-101
        • Hollenberg NK
        • Borucki LJ
        • Adams DF
        The renal vasculature in early essential hypertension: evidence for a pathogenetic role.
        Medicine (Baltimore). 1978; 57: 167-178
        • Williams GH
        • Rose LI
        • Dluhy RG
        • et al.
        Abnormal responsiveness of the renin aldosterone system to acute stimulation in patients with essential hypertension.
        Ann Intern Med. 1970; 72: 317-326
        • Moore TJ
        • Williams GH
        • Dluhy RG
        • Bavli SZ
        • Himathongkam T
        • Greenfield M
        Altered renin-angiotensin-aldosterone relationships in normal renin essential hypertension.
        Circ Res. 1977; 41: 167-171
        • Williams GH
        • Tuck ML
        • Sullivan JM
        • et al.
        Parallel adrenal and renal abnormalities in the young patients with essential hypertension.
        Am J Med. 1982; 72: 907-914
        • Shoback DM
        • Williams GH
        • Moore TJ
        • Dluhy RG
        • Podolsky S
        • Hollenberg NK
        Defect in the sodium-modulated tissue responsiveness to angiotensin II in essential hypertension.
        J Clin Invest. 1983; 72: 2115-2124
        • Hollenberg NK
        • Chenitz WR
        • Adams DF
        • Williams GH
        Reciprocal influence of salt intake on adrenal glomerulosa and renal vascular responses to angiotensin II in normal man.
        J Clin Invest. 1974; 54: 34-42
        • Oelkers W
        • Brown JJ
        • Fraser R
        • Lever AF
        • Morton JJ
        • Robertson JIS
        Sensitization of the adrenal cortex to angiotensin II in sodium-deplete man.
        Circ Res. 1974; 34: 69-77
        • Redgrave JE
        • Rabinowe SL
        • Hollenberg NK
        • Williams GH
        Correction of abnormal renal blood flow response to angiotensin II by converting enzyme inhibition in essential hypertension.
        J Clin Invest. 1985; 75: 1285-1290
        • Epstein M
        • Hollenberg NK
        Age as a determinant of renal sodium conservation in normal man.
        J Lab Clin Med. 1976; 87: 411-417
        • Black D
        Salt and hypertension.
        Br J Nutr. 1952; 6: 428-432
        • Strauss MB
        • Lamdin E
        • Smith WP
        • et al.
        Surfeit and deficit of sodium.
        Arch Intern Med. 1958; 102: 527-536
        • Uchida K
        • Morimoto S
        • Takeda R
        • Murakami M
        Studies on essential hypertension with suppressed plasma renin activity: sodium excretion pattern on salt restriction and effects of spironolactone on blood pressure and plasma renin activity.
        Jpn Circ J. 1972; 36: 1301-1311
        • Carey RM
        Evidence for a splanchnic sodium input monitor regulating renal sodium excretion in man.
        Circ Res. 1978; 43: 19-23
        • Gamble JL
        Chemical anatomy, physiology and pathology of extracellular fluid.
        Harvard University Press, Cambridge, Massachusetts1952
        • Talbot NB
        • Richie RH
        • Crawford JD
        Metabolic homeostasis.
        in: A syllabus for those concerned with the care of patients. Harvard University Press, Cambridge, Massachusetts1959
        • Pickering G
        2nd ed. High blood pressure. Grune & Stratton, New York1968
        • Romero JC
        • Staneloni RJ
        • Dufau ML
        • et al.
        Changes in fluid compartments, renal hemodynamics, plasma renin and aldosterone secretion induced by low sodium intake.
        Metabolism. 1970; 17: 10-19
        • Green DM
        • Ellis EJ
        Sodium output-blood pressure relationships and their modification by treatment.
        Circulation. 1954; 10: 536-543
        • Collier PT
        • Weller JM
        • Hoobler SW
        Sodium chloride excretion following salt loading in hypertensive subjects.
        Circulation. 1958; 18: 196-205
        • Buckalew Jr, VM
        • Puschett JB
        • Kintzel JE
        • Goldberg M
        Mechanism of exaggerated natriuresis in hypertensive man: impaired sodium transport in the loop of Henle.
        J Clin Invest. 1969; 48: 1007-1016
        • Krakoff LR
        • Goodwin FJ
        • Baer L
        • Torres M
        • Laragh JH
        The role of renin in the exaggerated natriuresis of hypertension.
        Circulation. 1970; 42: 335-345
        • Overbeck HW
        • Pamnani MB
        • Akera T
        • Brody TM
        • Haddy FJ
        Depressed function of a ouabain-sensitive sodium-potassium pump in blood vessels from renal hypertensive dogs.
        Circ Res. 1976; 38: 48-52
        • Haddy FJ
        • Pamnani MB
        • Clough DL
        Humoral factors and the sodium-potassium pump in volume expanded hypertension.
        Life Sci. 1979; 24: 2105-2118
        • Poston L
        • Sewell RB
        • Wilkinson SP
        • et al.
        Evidence for a circulating sodium transport inhibitor in essential hypertension.
        Br Med J. 1981; 282: 847-849