Alterations in blood pressure by derangement of the mechanisms that regulate sodium excretion

Blunted pressure natriuresis in ovariectomized Dahl-Iwai salt-sensitive rats

Our objective was to determine whether increased salt sensitivity after menopause precedes the development of overt hypertension. We investigated the effect of ovariectomy on pressure natriuresis in Dahl-Iwai salt-sensitive (DS) and salt-resistant (DR) rats by in vivo perfusion studies. Differences in the neural and hormonal backgrounds of the kidney were minimized by renal denervation and by holding plasma vasopressin, aldosterone, corticosterone, and norepinephrine levels constant by intravenous infusion. The pressure-natriuresis relationship was blunted in DS rats compared with DR rats (slope, 0.30 versus 0.63 mumol.min-1.g kidney wt-1.mm Hg-1, P < .01). The impaired pressure-natriuresis response of DS rats was further blunted by ovariectomy (from 0.30 to 0.14 mumol.min-1.g kidney wt-1.mm Hg-1, P < .05), and that of DR rats was not. The ovariectomized DS rats developed hypertension earlier than sham-operated DS rats by salt loading. These results show that ovariectomy enhances genetic salt sensitivity by blunting the pressure-natriuresis relationship, which precedes the development of overt hypertension in female DS rats.

Pressure dependent modulation of renin release in isolated perfused glomeruli

The isolated perfused glomerulus technique was used to study pressure dependence of renin release in single, microdissected rabbit glomeruli with intact afferent arteriole and intact Bowman's capsule. Renin release from individual afferent-glomerular units was measured in 30 minute intervals while afferent arteriolar pressure was either decreased from 55 to 40 to 25 mm Hg or increased from 25 to 40 to 55 mm Hg. There was a clear, inverse relation of renin release and afferent pressure. Mean renin release rate was 3.2 times higher at 25 than at 55 mm Hg and 1.5 times higher at 40 than at 55 mm Hg. To evaluate the possible role of wall stretch in mediating this response, inner and outer afferent arteriolar diameters were measured by videomicroscopy. Outer afferent diameter remained constant between 25 and 55 mm Hg, whereas inner diameter exhibited a slight increase. Changes of afferent arteriolar wall stretch, however, did not correlate with changes of renin release. These data for the first time directly demonstrate the existence of a renin baroceptor at the level of the renal afferent arteriole. They furthermore suggest that this baroceptor is not a stretch receptor.

Research and policy directions. Salt and blood pressure

The relation between dietary intake of sodium chloride and blood pressure levels remains controversial. The critical questions concern whether there is a susceptible subgroup at risk of elevated blood pressure because of sodium chloride consumption. If there is such a subgroup, what is its size and how can it be identified? Further clinical trials are needed to determine the long-term effects of sodium chloride reduction on blood pressure. The risk of disease, including stroke and coronary heart disease, is linear with blood pressure levels. A small change in blood pressure can have a relatively large impact on disease, even within the normal range of blood pressure.