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Butler HM, McCrorey MK, Palygina L, Lacey R, Van Beusecum JP. Salt-sensitive hypertension: role of endothelial and vascular dysfunction and sex. Front Pharmacol 2025; 16:1565962. [PMID: 40144661 PMCID: PMC11936959 DOI: 10.3389/fphar.2025.1565962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Accepted: 02/24/2025] [Indexed: 03/28/2025] Open
Abstract
For the last 120 years, the contribution of salt has been identified in the pathophysiological elevation of blood pressure. Since then, both human and experimental murine studies have begun to elucidate the key mechanisms contributing to the development of salt-sensitive hypertension. Numerous mechanisms, including increased plasma volume, sodium retention, impaired autoregulatory capability, inflammation, and endothelial and vascular dysfunction, contribute to deleterious elevations in blood pressure during salt sensitivity. The endothelium plays a critical role in blood flow regulation, renal blood flow, and blood pressure elevations and in migrating immune cells to end-organs, contributing to end-organ damage and fibrosis. In this review, we will consider the clinical studies setting the foundation for the definition of salt-sensitive hypertension, murine models to study endothelial and vascular contributions, and endothelial cell cultures that have shed light on signaling mechanisms. Lastly, we will discuss the sex-dependent physiology and mechanisms contributing to salt-sensitive hypertension development and their clinical implications.
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Affiliation(s)
- Helen M. Butler
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Marice K. McCrorey
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
- College of Graduate Studies, Medical University of South Carolina, Charleston, SC, United States
| | - Lada Palygina
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Ryan Lacey
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Justin P. Van Beusecum
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
- Ralph H. Johnson VA Healthcare System, Charleston, SC, United States
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Gafane-Matemane LF, Craig A, Kruger R, Alaofin OS, Ware LJ, Jones ESW, Kengne AP. Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities. J Hum Hypertens 2025; 39:95-110. [PMID: 38698111 PMCID: PMC11867975 DOI: 10.1038/s41371-024-00913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus . To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.
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Affiliation(s)
- Lebo F Gafane-Matemane
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa.
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa.
| | - Ashleigh Craig
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa
| | - Omotayo S Alaofin
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University, Mthatha, South Africa
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Flack JM, Bitner S, Buhnerkempe M. Evolving the Role of Black Race in Hypertension Therapeutics. Am J Hypertens 2024; 37:739-744. [PMID: 39022802 DOI: 10.1093/ajh/hpae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/30/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024] Open
Abstract
Black race has been used to guide antihypertensive drug selection for Black patients based on predominant between race (same drug) and intra-race (different drugs) blood pressure (BP) response patterns. Accordingly, thiazide diuretics and calcium antagonists have been recommended over renin-angiotensin system (RAS) inhibitors (angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors) and beta blockers for Black patients. Current antihypertensive drug prescribing reflects historical guidance as calcium antagonists and thiazide diuretics are prescribed more and RAS blockers less in Black than White patients. Hypertension control rates in Blacks, lag those for Whites despite their greater use of combination drug therapy and lesser use of monotherapy. This is also true across drug regimens containing any of the 4 recommended classes for initial therapy as well as for evidence-based combination drug therapy (calcium antagonist or thiazide diuretic + RAS blocker) regimens for which there is no known racial disparity in BP response. Current recommendations acknowledge the need for combination drug therapy in most, especially in Black patients. One exemplary comprehensive hypertension control program achieved >80% control rates in Black and White patients with minimal racial disparity while utilizing a race-agnostic therapeutic algorithm. Black patients manifest robust, if not outsized, BP responses to diet/lifestyle modifications. Importantly, race neither appears to be a necessary nor sufficient consideration for the selection of effective drug therapy. Accordingly, we urge the initiation of adequately intense race-agnostic drug therapy coupled with greater emphasis on diet/lifestyle modifications for Black patients as the cornerstone of a race-informed approach to hypertension therapeutics.
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Affiliation(s)
- John M Flack
- Hypertension Section, Division of General Internal Medicine, Department of Medicine, Southern Illinois University School of Medicine, Springfield IL, USA
| | - Stephanie Bitner
- Hypertension Section, Division of General Internal Medicine, Department of Medicine, Southern Illinois University School of Medicine, Springfield IL, USA
| | - Michael Buhnerkempe
- Department of Medicine, Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA
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Xu C, Dong J, Liu D, Xu J, Zhang B, Lu Z, Wang L, Tang J, Zhang X, Ren J, Yu X, Guo R, Guo X, Wu J, Ma J. Association between spot urinary sodium-to-potassium ratio and blood pressure among Chinese adults aged 18-69 years: the SMASH study. Front Nutr 2024; 11:1383243. [PMID: 38903621 PMCID: PMC11188376 DOI: 10.3389/fnut.2024.1383243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/14/2024] [Indexed: 06/22/2024] Open
Abstract
Background Excessive sodium and low potassium intake are involved in the development of hypertension. Growing evidence showed that the sodium-to-potassium ratio (Na/K) was significantly associated with blood pressure (BP). However, studies on the dose-response relationship of spot urinary Na/K ratio with hypertension and BP in the general population are scarce, especially in the Chinese population. Materials and methods Data from the post-intervention survey of the Shandong Ministry of Health Action on Salt and Hypertension (SMASH) project was analyzed. Associations between Na/K molar ratio and hypertension prevalence and between Na/K molar ratio and BP indices were analyzed using multivariable logistic and linear regression, respectively, followed by subgroup analysis and interaction analysis. The restricted cubic spline model was used to explore the dose-response relationship. Informed by existing literature, we adjusted for potential confounding factors, including temperature and renal function, to assess the association and dose-response relationship. Results There was a non-linear positive association between Na/K and hypertension (OR:1.09, 95%CI: 1.08-1.11) and a linear positive association between Na/K and systolic BP, diastolic BP, and mean arterial pressure (β 0.53, 95%CI: 0.45-0.60; β 0.36, 95%CI: 0.31-0.41; and β 0.42, 95%CI: 0.36-0.47, respectively). The association was stronger in individuals with hypertension, female patients, those in the 50-59-year age group, and those who were obese. Environmental temperatures had little impact on associations. Conclusion Our findings provide further evidence that the spot urinary Na/K ratio is a simple, useful, and convenient indicator for monitoring salt reduction and potassium increase, which could be used in clinical and public health practices.
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Affiliation(s)
- Chunxiao Xu
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Jing Dong
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Danru Liu
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bingyin Zhang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Zilong Lu
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Junli Tang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Xiaochang Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Ren
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Xiaohui Yu
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Rui Guo
- School of Public Health, Shandong University, Jinan, Shandong, China
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jixiang Ma
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
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Nishimoto M, Griffin KA, Wynne BM, Fujita T. Salt-Sensitive Hypertension and the Kidney. Hypertension 2024; 81:1206-1217. [PMID: 38545804 DOI: 10.1161/hypertensionaha.123.21369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Salt-sensitive hypertension (SS-HT) is characterized by blood pressure elevation in response to high dietary salt intake and is considered to increase the risk of cardiovascular and renal morbidity. Although the mechanisms responsible for SS-HT are complex, the kidneys are known to play a central role in the development of SS-HT and the salt sensitivity of blood pressure (SSBP). Moreover, several factors influence renal function and SSBP, including the renin-angiotensin-aldosterone system, sympathetic nervous system, obesity, and aging. A phenotypic characteristic of SSBP is aberrant activation of the renin-angiotensin system and sympathetic nervous system in response to excessive salt intake. SSBP is also accompanied by a blunted increase in renal blood flow after salt loading, resulting in sodium retention and SS-HT. Obesity is associated with inappropriate activation of the aldosterone mineralocorticoid receptor pathway and renal sympathetic nervous system in response to excessive salt, and mineralocorticoid receptor antagonists and renal denervation attenuate sodium retention and inhibit salt-induced blood pressure elevation in obese dogs and humans. SSBP increases with age, which has been attributed to impaired renal sodium handling and a decline in renal function, even in the absence of kidney disease. Aging-associated changes in renal hemodynamics are accompanied by significant alterations in renal hormone levels and renal sodium handling, resulting in SS-HT. In this review, we focus mainly on the contribution of renal function to the development of SS-HT.
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Affiliation(s)
- Mitsuhiro Nishimoto
- Department of Internal Medicine, Division of Nephrology & Hypertension, International University of Health and Welfare Mita Hospital, Tokyo, Japan (M.N.)
| | - Karen A Griffin
- Department of Medicine, Renal Disease & Hypertension, Loyola University, Chicago, IL (K.A.G.)
- Veteran's Administration, Nephrology, Edward Hines Jr. VA Hospital (K.A.G.)
| | - Brandi M Wynne
- Department of Internal Medicine, Nephrology & Hypertension, Department of Nutrition and Integrative Physiology, and Immunology, Inflammation and Infectious Disease Initiative (B.M.W.), University of Utah, Salt Lake City
| | - Toshiro Fujita
- Division of Clinical Epigenetics, Research Center for Advanced Science & Technology, The University of Tokyo, Japan (T.F.)
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Bielopolski D, Musante L, Hoorn EJ, Molina H, Barrows D, Carrol TS, Harding MA, Upson S, Qureshi A, Weder MM, Tobin JN, Kost RG, Erdbrügger U. Effect of the DASH diet on the sodium-chloride cotransporter and aquaporin-2 in urinary extracellular vesicles. Am J Physiol Renal Physiol 2024; 326:F971-F980. [PMID: 38634133 PMCID: PMC11386975 DOI: 10.1152/ajprenal.00274.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/19/2024] Open
Abstract
The dietary approach to stop hypertension (DASH) diet combines the antihypertensive effect of a low sodium and high potassium diet. In particular, the potassium component of the diet acts as a switch in the distal convoluted tubule to reduce sodium reabsorption, similar to a diuretic but without the side effects. Previous trials to understand the mechanism of the DASH diet were based on animal models and did not characterize changes in human ion channel protein abundance. More recently, protein cargo of urinary extracellular vesicles (uEVs) has been shown to mirror tissue content and physiological changes within the kidney. We designed an inpatient open label nutritional study transitioning hypertensive volunteers from an American style diet to DASH diet to examine physiological changes in adults with stage 1 hypertension otherwise untreated (Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER 3rd, Simons-Morton DG, Karanja N, Lin PH; DASH-Sodium Collaborative Research Group. N Engl J Med 344: 3-10, 2001). Urine samples from this study were used for proteomic characterization of a large range of pure uEVs (small to large) to reveal kidney epithelium changes in response to the DASH diet. These samples were collected from nine volunteers at three time points, and mass spectrometry identified 1,800 proteins from all 27 samples. We demonstrated an increase in total SLC12A3 [sodium-chloride cotransporter (NCC)] abundance and a decrease in aquaporin-2 (AQP2) in uEVs with this mass spectrometry analysis, immunoblotting revealed a significant increase in the proportion of activated (phosphorylated) NCC to total NCC and a decrease in AQP2 from day 5 to day 11. This data demonstrates that the human kidney's response to nutritional interventions may be captured noninvasively by uEV protein abundance changes. Future studies need to confirm these findings in a larger cohort and focus on which factor drove the changes in NCC and AQP2, to which degree NCC and AQP2 contributed to the antihypertensive effect and address if some uEVs function also as a waste pathway for functionally inactive proteins rather than mirroring protein changes.NEW & NOTEWORTHY Numerous studies link DASH diet to lower blood pressure, but its mechanism is unclear. Urinary extracellular vesicles (uEVs) offer noninvasive insights, potentially replacing tissue sampling. Transitioning to DASH diet alters kidney transporters in our stage 1 hypertension cohort: AQP2 decreases, NCC increases in uEVs. This aligns with increased urine volume, reduced sodium reabsorption, and blood pressure decline. Our data highlight uEV protein changes as diet markers, suggesting some uEVs may function as waste pathways. We analyzed larger EVs alongside small EVs, and NCC in immunoblots across its molecular weight range.
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Affiliation(s)
- Dana Bielopolski
- The Rockefeller University Center for Clinical and Translational Science, New York, New York, United States
| | - Luca Musante
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ewout J Hoorn
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henrik Molina
- Proteomics Resource Center, Rockefeller University, New York, New York, United States
| | - Douglas Barrows
- Bioinformatics Resource Center, Rockefeller University, New York, New York, United States
| | - Thomas S Carrol
- Bioinformatics Resource Center, Rockefeller University, New York, New York, United States
| | - Michael A Harding
- Division of Nephrology, Department of Medicine, University of Virginia at Charlottesville, Charlottesville, Virginia, United States
| | - Samantha Upson
- Division of Nephrology, Department of Medicine, University of Virginia at Charlottesville, Charlottesville, Virginia, United States
| | - Adam Qureshi
- The Rockefeller University Center for Clinical and Translational Science, New York, New York, United States
| | - Max M Weder
- Division of Pulmonology, Department of Medicine, University of Virginia at Charlottesville, Charlottesville, Virginia, United States
| | - Jonathan N Tobin
- The Rockefeller University Center for Clinical and Translational Science, New York, New York, United States
- Clinical Directors Network, New York, New York, United States
| | - Rhonda G Kost
- The Rockefeller University Center for Clinical and Translational Science, New York, New York, United States
| | - U Erdbrügger
- Division of Nephrology, Department of Medicine, University of Virginia at Charlottesville, Charlottesville, Virginia, United States
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Balvers M, de Goffau M, van Riel N, van den Born BJ, Galenkamp H, Zwinderman K, Nieuwdorp M, Levin E. Ethnic variations in metabolic syndrome components and their associations with the gut microbiota: the HELIUS study. Genome Med 2024; 16:41. [PMID: 38509598 PMCID: PMC10953122 DOI: 10.1186/s13073-024-01295-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/22/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The occurrence of metabolic syndrome (MetS) and the gut microbiota composition are known to differ across ethnicities yet how these three factors are interwoven is unknown. Also, it is unknown what the relative contribution of the gut microbiota composition is to each MetS component and whether this differs between ethnicities. We therefore determined the occurrence of MetS and its components in the multi-ethnic HELIUS cohort and tested the overall and ethnic-specific associations with the gut microbiota composition. METHODS We included 16,209 treatment naïve participants of the HELIUS study, which were of Dutch, African Surinamese, South-Asian Surinamese, Ghanaian, Turkish, and Moroccan descent to analyze MetS and its components across ethnicities. In a subset (n = 3443), the gut microbiota composition (16S) was associated with MetS outcomes using linear and logistic regression models. RESULTS A differential, often sex-dependent, prevalence of MetS components and their combinations were observed across ethnicities. Increased blood pressure was commonly seen especially in Ghanaians, while South-Asian Surinamese and Turkish had higher MetS rates in general and were characterized by worse lipid-related measures. Regarding the gut microbiota, when ethnic-independent associations were assumed, a higher α-diversity, higher abundance of several ASVs (mostly for waist and triglyceride-related outcomes) and a trophic network of ASVs of Ruminococcaceae, Christensenellaceae, and Methanobrevibacter (RCM) bacteria were associated with better MetS outcomes. Statistically significant ethnic-specific associations were however noticed for α-diversity and the RCM trophic network. Associations were significant in the Dutch but not always in all other ethnicities. In Ghanaians, a higher α-diversity and RCM network abundance showed an aberrant positive association with high blood pressure measures compared to the other ethnicities. Even though adjustment for socioeconomic status-, lifestyle-, and diet-related variables often attenuated the effect size and/or the statistical significance of the ethnic-specific associations, an overall similar pattern across outcomes and ethnicities remained. CONCLUSIONS The occurrence of MetS characteristics among ethnicities is heterogeneous. Both ethnic-independent and ethnic-specific associations were identified between the gut microbiota and MetS outcomes. Across multiple ethnicities, a one-size-fits-all approach may thus be reconsidered in regard to both the definition and/or treatment of MetS and its relation to the gut microbiota.
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Affiliation(s)
- Manon Balvers
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Marcus de Goffau
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- HORAIZON Technology BV, Marshallaan 2, Delft, 2625 GZ, The Netherlands
| | - Natal van Riel
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Bert-Jan van den Born
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Koos Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Amsterdam University Medical Centers, Amsterdam, 1105 AZ, The Netherlands
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Evgeni Levin
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
- HORAIZON Technology BV, Marshallaan 2, Delft, 2625 GZ, The Netherlands.
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Abstract
Excessive salt intake raises blood pressure, but the implications of this observation for human health have remained contentious. It has also been recognized for many years that potassium intake may mitigate the effects of salt intake on blood pressure and possibly on outcomes such as stroke. Recent large randomized intervention trials have provided strong support for the benefits of replacing salt (NaCl) with salt substitute (75% NaCl, 25% KCl) on hard outcomes, including stroke. During the same period of time, major advances have been made in understanding how the body senses and tastes salt, and how these sensations drive intake. Additionally, new insights into the complex interactions between systems that control sodium and potassium excretion by the kidneys, and the brain have highlighted the existence of a potassium switch in the kidney distal nephron. This switch seems to contribute importantly to the blood pressure-lowering effects of potassium intake. In recognition of these evolving data, the United States Food and Drug Administration is moving to permit potassium-containing salt substitutes in food manufacturing. Given that previous attempts to reduce salt consumption have not been successful, this new approach has a chance of improving health and ending the 'Salt Wars'.
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Affiliation(s)
- Robert Little
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- LeDucq Transatlantic Network of Excellence
| | - David H. Ellison
- Division of Nephrology and Hypertension, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, Oregon, USA
- LeDucq Transatlantic Network of Excellence
- VA Portland Health Care System, Portland, OR
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Abstract
Salt (sodium chloride) is an essential nutrient required to maintain physiological functions. However, for most people, daily salt intake far exceeds their physiological need and is habitually greater than recommended upper thresholds. Excess salt intake leads to elevation in blood pressure which drives cardiovascular morbidity and mortality. Indeed, excessive salt intake is estimated to be responsible for ≈5 million deaths per year globally. For approximately one-third of otherwise healthy individuals (and >50% of those with hypertension), the effect of salt intake on blood pressure elevation is exaggerated; such people are categorized as salt sensitive and salt sensitivity of blood pressure is considered an independent risk factor for cardiovascular disease and death. The prevalence of salt sensitivity is higher in women than in men and, in both, increases with age. This narrative review considers the foundational concepts of salt sensitivity and the underlying effector systems that cause salt sensitivity. We also consider recent updates in preclinical and clinical research that are revealing new modifying factors that determine the blood pressure response to high salt intake.
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Affiliation(s)
- Matthew A Bailey
- Edinburgh Kidney, University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, United Kingdom (M.A.B., N.D.)
| | - Neeraj Dhaun
- Edinburgh Kidney, University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, United Kingdom (M.A.B., N.D.)
- Department of Renal Medicine, Royal Infirmary of Edinburgh, United Kingdom (N.D.)
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10
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Zhang Y, Miyai N, Utsumi M, Miyashita K, Arita M. Spot urinary sodium-to-potassium ratio is associated with blood pressure levels in healthy adolescents: the Wakayama Study. J Hum Hypertens 2024; 38:238-244. [PMID: 38114720 DOI: 10.1038/s41371-023-00883-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
The spot urinary sodium-to-potassium (Na/K) ratio is a simple measure of salt loading and has been shown to be associated with elevated blood pressure (BP) in middle-aged and older adults. This study aimed to evaluate the association between the spot urinary Na/K ratio and BP in 457 healthy adolescents aged 12-15 years in a school-based setting. The mean urinary Na/K ratio was 4.99 ± 2.76, and no significant difference was found between the boys and girls. When the participants were stratified based on urinary Na/K ratio quartile, age- and sex-adjusted systolic and diastolic BP gradually increased as Na/K ratio increased (systolic BP: 106.1, 106.9, 108.2, and 111.5 mmHg, Ptrend < 0.001; diastolic BP: 62.0, 62.4, 63.1, 64.3 mmHg, Ptrend = 0.022). The systolic and diastolic BP were more closely associated with urinary Na/K ratio than with Na and K levels, as well as estimated daily salt intake. In the multiple regression analysis, the urinary Na/K ratio was significantly associated with systolic BP (β = 0.144, P < 0.001) and diastolic BP (β = 0.114, P = 0.015) independent of potential confounding factors. An additional subgroup analysis revealed that the BP of the group with both high salt intake (≥8.5 g/day) and high Na/K ratio (≥6.60) was significantly higher than that of the group with high salt intake alone (systolic BP, 115.0 vs. 109.1 mmHg, P < 0.001; diastolic BP, 66.0 vs. 62.5 mmHg, P = 0.017). These results suggest that the urinary Na/K ratio is associated with BP levels in healthy adolescents and may be useful for assessing salt loading and its effects on BP elevation.
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Affiliation(s)
- Yan Zhang
- School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Nobuyuki Miyai
- School of Health and Nursing Science, Wakayama Medical University, Wakayama, Japan.
| | - Miyoko Utsumi
- Wakayama Faculty of Nursing, Tokyo Healthcare University, Wakayama, Japan
| | | | - Mikio Arita
- Sumiya Rehabilitation Hospital, Wakayama, Japan
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Elijovich F, Kirabo A, Laffer CL. Salt Sensitivity of Blood Pressure in Black People: The Need to Sort Out Ancestry Versus Epigenetic Versus Social Determinants of Its Causation. Hypertension 2024; 81:456-467. [PMID: 37767696 PMCID: PMC10922075 DOI: 10.1161/hypertensionaha.123.17951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Race is a social construct, but self-identified Black people are known to have higher prevalence and worse outcomes of hypertension than White people. This may be partly due to the disproportionate incidence of salt sensitivity of blood pressure in Black people, a cardiovascular risk factor that is independent of blood pressure and has no proven therapy. We review the multiple physiological systems involved in regulation of blood pressure, discuss what, if anything is known about the differences between Black and White people in these systems and how they affect salt sensitivity of blood pressure. The contributions of genetics, epigenetics, environment, and social determinants of health are briefly touched on, with the hope of stimulating further work in the field.
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Affiliation(s)
- Fernando Elijovich
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Cheryl L Laffer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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Sriperumbuduri S, Welling P, Ruzicka M, Hundemer GL, Hiremath S. Potassium and Hypertension: A State-of-the-Art Review. Am J Hypertens 2024; 37:91-100. [PMID: 37772757 DOI: 10.1093/ajh/hpad094] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 09/30/2023] Open
Abstract
Hypertension is the single most important and modifiable risk factor for cardiovascular morbidity and mortality worldwide. Non pharmacologic interventions, in particular dietary modifications have been established to decrease blood pressure (BP) and hypertension related adverse cardiovascular events. Among those dietary modifications, sodium intake restriction dominates guidelines from professional organizations and has garnered the greatest attention from the mainstream media. Despite guidelines and media exhortations, dietary sodium intake globally has not noticeably changed over recent decades. Meanwhile, increasing dietary potassium intake has remained on the sidelines, despite similar BP-lowering effects. New research reveals a potential mechanism of action, with the elucidation of its effect on natriuresis via the potassium switch effect. Additionally, potassium-substituted salt has been shown to not only reduce BP, but also reduce the risk for stroke and cardiovascular mortality. With these data, we argue that the focus on dietary modification should shift from a sodium-focused to a sodium- and potassium-focused approach with an emphasis on intervention strategies which can easily be implemented into clinical practice.
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Affiliation(s)
- Sriram Sriperumbuduri
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paul Welling
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Gregory L Hundemer
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
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Jeong S, Hunter SD, Cook MD, Grosicki GJ, Robinson AT. Salty Subjects: Unpacking Racial Differences in Salt-Sensitive Hypertension. Curr Hypertens Rep 2024; 26:43-58. [PMID: 37878224 PMCID: PMC11414742 DOI: 10.1007/s11906-023-01275-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE OF REVIEW To review underlying mechanisms and environmental factors that may influence racial disparities in the development of salt-sensitive blood pressure. RECENT FINDINGS Our group and others have observed racial differences in diet and hydration, which may influence salt sensitivity. Dietary salt elicits negative alterations to the gut microbiota and immune system, which may increase hypertension risk, but little is known regarding potential racial differences in these physiological responses. Antioxidant supplementation and exercise offset vascular dysfunction following dietary salt, including in Black adults. Furthermore, recent work proposes the role of racial differences in exposure to social determinants of health, and differences in health behaviors that may influence risk of salt sensitivity. Physiological and environmental factors contribute to the mechanisms that manifest in racial differences in salt-sensitive blood pressure. Using this information, additional work is needed to develop strategies that can attenuate racial disparities in salt-sensitive blood pressure.
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Affiliation(s)
- Soolim Jeong
- Neurovascular Physiology Laboratory (NVPL), School of Kinesiology, Auburn University, Auburn, AL, 36849, USA
| | - Stacy D Hunter
- Department of Health & Human Performance, Texas State University, San Marcos, TX, 78666, USA
| | - Marc D Cook
- Department of Kinesiology, North Carolina Agriculture and Technology State University, Greensboro, NC, 27411, USA
| | - Gregory J Grosicki
- Biodynamics and Human Performance Center, Georgia Southern University (Armstrong Campus), Savannah, GA, 31419, USA
| | - Austin T Robinson
- Neurovascular Physiology Laboratory (NVPL), School of Kinesiology, Auburn University, Auburn, AL, 36849, USA.
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14
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Yu YL, Moliterno P, An DW, Raaijmakers A, Martens DS, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Chori B, Filipovský J, Rajzer M, Allegaert K, Kawecka-Jaszcz K, Verhamme P, Nawrot TS, Staessen JA, Boggia J. Blood pressure and cardiovascular risk in relation to birth weight and urinary sodium: an individual-participant meta-analysis of European family-based population studies. J Hypertens 2023; 41:1175-1183. [PMID: 37074387 PMCID: PMC10242514 DOI: 10.1097/hjh.0000000000003447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Although the relation of salt intake with blood pressure (BP) is linear, it is U-shaped for mortality and cardiovascular disease (CVD). This individual-participant meta-analysis explored whether the relation of hypertension, death or CVD with 24-h urinary sodium excretion (UVNA) or sodium-to-potassium (UNAK) ratio was modified by birth weight. METHODS Families were randomly enrolled in the Flemish Study on Genes, Environment and Health Outcomes (1985-2004) and the European Project on Genes in Hypertension (1999-2001). Categories of birth weight, UVNA and UNAK (≤2500, >2500-4000, >4000 g; <2.3, 2.3-4.6 and >4.6 g; and <1, 1-2, >2, respectively) were coded using deviation-from-mean coding and analyzed by Kaplan-Meier survival functions and linear and Cox regression. RESULTS The study population was subdivided into the Outcome ( n = 1945), Hypertension ( n = 1460) and Blood Pressure cohorts ( n = 1039) to analyze the incidence of mortality and cardiovascular endpoints, hypertension and BP changes as function of UVNA changes. The prevalence of low/medium/high birth weight in the Outcome cohort was 5.8/84.5/9.7%. Over 16.7 years (median), rates were 4.9, 8 and 27.1% for mortality, CVD and hypertension, respectively, but were not associated with birth weight. Multivariable-adjusted hazard ratios were not significant for any endpoint in any of the birth weight, UVNA and UNAK strata. Adult body weight tracked with birth weight ( P < 0.0001). The partial r in the low-birth-weight group associating changes from baseline to follow-up in UVNA and SBP was 0.68 ( P = 0.023) but not significant in other birth weight groups. CONCLUSION This study did not substantiate its prior hypothesis but showed tracking of adult with birth weight and suggest that low birth weight increases salt sensitivity.
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Affiliation(s)
- Yu-Ling Yu
- Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
| | - Paula Moliterno
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - De-Wei An
- Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
| | - Anke Raaijmakers
- KU Leuven Department of Development and Regeneration, University of Leuven, Leuven
- Department of Pediatrics, ZNA Hospital Network Antwerp, Antwerp
| | - Dries S. Martens
- Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | | | - Sofia Malyutina
- Institute of Internal and Preventive Medicine, Internal and Preventive Medicine - Branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science, Novosibirsk, Russian Federation
| | | | - Babangida Chori
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Jan Filipovský
- Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Karel Allegaert
- KU Leuven Department of Development and Regeneration, University of Leuven, Leuven
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Peter Verhamme
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, and
| | - Tim S. Nawrot
- Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven
- Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jan A. Staessen
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - José Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
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Ito Y, Sun T, Tanaka H, Yamaguchi M, Kinashi H, Sakata F, Kunoki S, Sakai Y, Ishimoto T. Tissue Sodium Accumulation Induces Organ Inflammation and Injury in Chronic Kidney Disease. Int J Mol Sci 2023; 24:ijms24098329. [PMID: 37176037 PMCID: PMC10179540 DOI: 10.3390/ijms24098329] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
High salt intake is a primary cause of over-hydration in chronic kidney disease (CKD) patients. Inflammatory markers are predictors of CKD mortality; however, the pathogenesis of inflammation remains unclear. Sodium storage in tissues has recently emerged as an issue of concern. The binding of sodium to tissue glycosaminoglycans and its subsequent release regulates local tonicity. Many cell types express tonicity-responsive enhancer-binding protein (TonEBP), which is activated in a tonicity-dependent or tonicity-independent manner. Macrophage infiltration was observed in the heart, peritoneal wall, and para-aortic tissues in salt-loading subtotal nephrectomized mice, whereas macrophages were not prominent in tap water-loaded subtotal nephrectomized mice. TonEBP was increased in the heart and peritoneal wall, leading to the upregulation of inflammatory mediators associated with cardiac fibrosis and peritoneal membrane dysfunction, respectively. Reducing salt loading by a diuretic treatment or changing to tap water attenuated macrophage infiltration, TonEBP expression, and inflammatory marker expression. The role of TonEBP may be crucial during the cardiac fibrosis and peritoneal deterioration processes induced by sodium overload. Anti-interleukin-6 therapy improved cardiac inflammation and fibrosis and peritoneal membrane dysfunction. Further studies are necessary to establish a strategy to regulate organ dysfunction induced by TonEBP activation in CKD patients.
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Affiliation(s)
- Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Ting Sun
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Hiroya Tanaka
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Makoto Yamaguchi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Hiroshi Kinashi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Fumiko Sakata
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 464-0813, Japan
| | - Shunnosuke Kunoki
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
- Department of Nephrology, Nippon Medical School, Tokyo 113-8602, Japan
| | - Yukinao Sakai
- Department of Nephrology, Nippon Medical School, Tokyo 113-8602, Japan
| | - Takuji Ishimoto
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
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16
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Mosallanezhad Z, Jalali M, Bahadoran Z, Mirmiran P, Azizi F. Dietary sodium to potassium ratio is an independent predictor of cardiovascular events: a longitudinal follow-up study. BMC Public Health 2023; 23:705. [PMID: 37072769 PMCID: PMC10111692 DOI: 10.1186/s12889-023-15618-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/06/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND The current prospective cohort study aimed to explore the potential associations between dietary sodium (Na), potassium (K), and sodium-to-potassium (Na-to-K) ratio with an incidence risk of cardiovascular disease (CVD) among Iranian adults. METHODS The participants of the Tehran Lipid and Glucose Study (men and women aged 30-84 years, n = 2050), free of CVD at baseline (2006-2008) were included. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ), and incident CVD (i.e., coronary heart disease, stroke, and CVD mortality) were documented up to March 2018. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) regarding the association between dietary Na, K, and Na-to-K ratio with CVD events. RESULTS During a median follow-up of 10.6 years, 10.14% of participants experienced CVD outcomes. A 41% increased risk of CVD in relation to each increase in 1000 mg/d of Na intake. In the fully-adjusted model, higher Na intake (> 4143 versus < 3049 mg/d) was significantly related to the increased risk of CVD (HR = 1.99, 95% CI = 1.06-3.74). Independent of the well-known risk factors, a 56% reduced risk of CVD was observed in the participants with a higher dietary K intake (HR = 0.44, 95% CI = 0.20-0.94). A Higher Na-to-K ratio was associated with an increased risk of CVD (HR = 1.99, 95% CI = 1.13-3.52). CONCLUSION Our study showed that the Na-to-K ratio might independently predict future risk of CVD events in adults.
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Affiliation(s)
- Zahra Mosallanezhad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Shahid-Erabi St., Yeman St, P.O.Box: 19395-4763, Velenjak, Tehran, Iran
| | - Mohammad Jalali
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Shahid-Erabi St., Yeman St, P.O.Box: 19395-4763, Velenjak, Tehran, Iran
| | - Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Shahid-Erabi St., Yeman St, P.O.Box: 19395-4763, Velenjak, Tehran, Iran.
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Johnston JG, Welch AK, Cain BD, Sayeski PP, Gumz ML, Wingo CS. Aldosterone: Renal Action and Physiological Effects. Compr Physiol 2023; 13:4409-4491. [PMID: 36994769 PMCID: PMC11472823 DOI: 10.1002/cphy.c190043] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Aldosterone exerts profound effects on renal and cardiovascular physiology. In the kidney, aldosterone acts to preserve electrolyte and acid-base balance in response to changes in dietary sodium (Na+ ) or potassium (K+ ) intake. These physiological actions, principally through activation of mineralocorticoid receptors (MRs), have important effects particularly in patients with renal and cardiovascular disease as demonstrated by multiple clinical trials. Multiple factors, be they genetic, humoral, dietary, or otherwise, can play a role in influencing the rate of aldosterone synthesis and secretion from the adrenal cortex. Normally, aldosterone secretion and action respond to dietary Na+ intake. In the kidney, the distal nephron and collecting duct are the main targets of aldosterone and MR action, which stimulates Na+ absorption in part via the epithelial Na+ channel (ENaC), the principal channel responsible for the fine-tuning of Na+ balance. Our understanding of the regulatory factors that allow aldosterone, via multiple signaling pathways, to function properly clearly implicates this hormone as central to many pathophysiological effects that become dysfunctional in disease states. Numerous pathologies that affect blood pressure (BP), electrolyte balance, and overall cardiovascular health are due to abnormal secretion of aldosterone, mutations in MR, ENaC, or effectors and modulators of their action. Study of the mechanisms of these pathologies has allowed researchers and clinicians to create novel dietary and pharmacological targets to improve human health. This article covers the regulation of aldosterone synthesis and secretion, receptors, effector molecules, and signaling pathways that modulate its action in the kidney. We also consider the role of aldosterone in disease and the benefit of mineralocorticoid antagonists. © 2023 American Physiological Society. Compr Physiol 13:4409-4491, 2023.
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Affiliation(s)
- Jermaine G Johnston
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida, USA
- Nephrology Section, Veteran Administration Medical Center, North Florida/South Georgia Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, Florida, USA
| | - Amanda K Welch
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida, USA
- Nephrology Section, Veteran Administration Medical Center, North Florida/South Georgia Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, Florida, USA
| | - Brian D Cain
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, Florida, USA
| | - Peter P Sayeski
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida, USA
| | - Michelle L Gumz
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida, USA
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, Florida, USA
- Nephrology Section, Veteran Administration Medical Center, North Florida/South Georgia Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, Florida, USA
| | - Charles S Wingo
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida, USA
- Nephrology Section, Veteran Administration Medical Center, North Florida/South Georgia Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, Florida, USA
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Abstract
PURPOSE OF REVIEW To provide a summary of current literature and propose potential mechanistic models to help us understand the role of HIV infection/antiretroviral therapy (ART), salt taste sensitivity (STS), and salt sensitivity of blood pressure (SSBP) in hypertension development. RECENT FINDINGS The epithelial sodium channel (ENaC) is the main protein/sodium channel for recognizing Na + in the tongue and mediates preference to low-medium salt concentrations in animals and humans. Considering the pressor response to oral salt in individuals with SSBP, poor STS may worsen blood pressure. Specific genetic variants in ENaC are linked to salt taste perception and hypertension. HIV infection, some ART, and specific antihypertensive drugs are associated with reduced STS and an increased liking for salty foods. Persons with HIV (PWH) on ART may have a decreased STS and are at a higher risk of developing salt-sensitive hypertension. Inflammation mediated by dietary salt is one of the drivers of poor STS and salt-sensitive hypertension among PWH.
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19
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Johnston JG, Wingo CS. Potassium Homeostasis and WNK Kinases in the Regulation of the Sodium-Chloride Cotransporter: Hyperaldosteronism and Its Metabolic Consequences. KIDNEY360 2022; 3:1823-1828. [PMID: 36514400 PMCID: PMC9717643 DOI: 10.34067/kid.0005752022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Jermaine G. Johnston
- Department of Medicine, University of Florida, Gainesville, Florida
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
- Veterans Administration Medical Center, North Florida/South Georgia Veterans Health Administration, Gainesville, Florida
| | - Charles S. Wingo
- Department of Medicine, University of Florida, Gainesville, Florida
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
- Veterans Administration Medical Center, North Florida/South Georgia Veterans Health Administration, Gainesville, Florida
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20
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The Influence of Binding of Selected Mycotoxin Deactivators and Aflatoxin M1 on the Content of Selected Micronutrients in Milk. Processes (Basel) 2022. [DOI: 10.3390/pr10112431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Milk containing aflatoxin M1 (ATM1) in quantities above 0.05 µg/kg is considered unsuitable for consumption. It is possible to use mycotoxin deactivators that bind aflatoxin M1 and allow the further use of milk. The study aimed to examine the impact of selected mycotoxin deactivators (beta-glucan from yeast and oats, and live and dead lactic acid bacteria) on the nutritional composition of milk after binding to aflatoxin M1 intentionally added to milk. The study used consumption milk with 2.8% milk fat intentionally contaminated with aflatoxin M1. Furthermore, 0.05% and 0.1% solutions of beta-glucan from yeast and beta-glucan from oats were added to the contaminated milk, as well as live and dead lactic acid. Concentrations of Na, K, Mg, and Ca were monitored at the zero hour of binding of mycotoxin deactivators and ATM1, after 2 h of binding, and after 4 and 24 h of binding. The largest deviations were found in Na, K, and Mg, while the minimum changes were observed in Ca. Live lactic acid bacteria were found to have the least impact on micronutrients, except in Na (difference = 40, p = 0.029, GES = 0.083), where the 0.1% solution from oats had the least impact on micronutrient content. The results of this study suggest that it is best to use live lactic acid bacteria where the different duration of action regarding nutrients, with the possible exception of Na, is not relevant, which indicates that, when using this mycotoxin deactivator, milk contaminated with ATM1 can be further used.
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21
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Xie Y, Qi H, Peng W, Li B, Wen F, Zhang F, Zhang L. Higher Potassium Intake and Lower Sodium Intake May Help in Reducing CVD Risk by Lowering Salt Sensitivity of Blood Pressure in the Han Chinese Population. Nutrients 2022; 14:nu14204436. [PMID: 36297119 PMCID: PMC9607620 DOI: 10.3390/nu14204436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 03/10/2023] Open
Abstract
Sodium (Na) reduction with a parallel supplemental potassium (K) intake can prevent cardiovascular diseases (CVDs). The relationship of the urinary Na/K ratio and salt sensitivity of blood pressure (SSBP) with CVDs is not clearly explained. We assumed that the SSBP mediates the relationship between the Na/K ratio and CVDs. In total, 2055 subjects who had 24 h urine collected and SSBP determined were included in this study. CVD risk was estimated using the China-PAR equation. MediationMultivariate logistic regression was used to explore the associations between the Na/K ratio or SSBP with CVD risk. Mediation analysis using a logistic regression model was performed. Both the urinary Na/K ratio and SSBP were related to the estimated CVD risk (p < 0.05). The mediation analysis found that SSBP mediated approximately 12% of the association between Na/K ratio and CVD risk. Our findings indicate that higher K intake and lower Na intake may help in preventing CVD risk by reducing SSBP risk in individuals with normotension or stage-one hypertension.
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Affiliation(s)
- Yunyi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Han Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Wenjuan Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Bingxiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Fuyuan Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Fengxu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
- Correspondence: ; Tel.: +86-10-83911777
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22
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Estimating the changing burden of disease attributable to high sodium intake in South Africa for 2000, 2006 and 2012. S Afr Med J 2022; 112:627-638. [DOI: 10.7196/samj.2022.v112i8b.16490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Indexed: 11/08/2022] Open
Abstract
Background. Elevated sodium consumption is associated with increased blood pressure, a major risk factor for cardiovascular and chronic kidney disease.Objectives. To quantify the deaths and disability-adjusted life years (DALYs) attributed to high sodium intake in persons aged ≥25 years in South Africa (SA) for 2000, 2006 and 2012.Methods. Comparative risk assessment (CRA) methodology was used and population attributable fractions (PAFs) of high sodium intake, mediated through high blood pressure (BP), for cardiovascular and chronic kidney disease were estimated. This was done by taking the difference between the PAF for elevated systolic BP (SBP) based on the estimated SBP level in the population and the PAF based on the estimated SBP that would result if sodium intake levels were reduced to the theoretical minimum risk exposure level (1 g/day) according to population group and hypertension categories. A meta-regression based on data from nine national surveys conducted between 1998 and 2017 was used to estimate the prevalence of hypertension by age, sex and population group. Relative risks identified from international literature were used and the difference in PAFs was applied to local burden estimates from the second South African National Burden of Disease Study. Age-standardised rates were calculated using World Health Organization (WHO) standard population weights. The attributable burden was also estimated for 2012 using an alternative target of 2 g/day proposed in the National Strategic Plan for the Prevention and Control of Non-communicable Diseases (NSP).Results. High sodium intake as mediated through high SBP was estimated to cause 8 071 (95% uncertainty interval (UI) 6 542 - 15 474) deaths in 2012, a drop from 9 574 (95% UI 8 158 - 16 526) in 2006 and 8 431 (95% UI 6 972 - 14 511) in 2000. In 2012, ischaemic heart disease caused the highest number of deaths in persons (n=1 832), followed by haemorrhagic stroke (n=1 771), ischaemic stroke (n=1 484) and then hypertensive heart disease (n=1 230). Ischaemic heart disease was the highest contributor to deaths for males (27%), whereas for females it was haemorrhagic stroke (23%). In 2012, 1.5% (95% UI 1.3 - 2.9) of total deaths and 0.7% (95% UI 0.6 - 1.2) of total DALYs were attributed to high sodium intake. If the NSP target of <2 g/day sodium intake had been achieved in 2012, ~2 943 deaths and 48 870 DALYs would have been averted.Conclusion. Despite a slight decreasing trend since 2006, high sodium intake mediated through raised BP accounted for a sizeable burden of disease in 2012. Realising SA’s target to reduce sodium intake remains a priority, and progress requires systematic monitoring and evaluation.
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The Effectiveness of Nutritional Education Interventions on Dietary Intake in Young Black Males: A Near-Empty Systematic Review. Nutrients 2022; 14:nu14112264. [PMID: 35684062 PMCID: PMC9182654 DOI: 10.3390/nu14112264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023] Open
Abstract
The incidence of several diet and lifestyle-related diseases, previously seen only in adults, is increasing in prevalence in young people. The Black population, and particularly Black males, are at high risk of developing lifestyle-related diseases. Adolescence and young adulthood are considered a transitional period with increasing independence and responsibility, along with the development of lifelong lifestyle habits. This systematic review aimed to establish which methods and approaches to nutritional education interventions are the most effective in improving the nutritional/dietary intake in healthy young Black males. Eligibility criteria were designed using PICOS and included controlled trials of nutrition education interventions designed to improve dietary intake in healthy young Black or mixed-race males aged 14–21 years old. Medline, Cinahl and Scopus were searched in April 2021, resulting in 20,375 records being screened, and subsequently 72 full-text articles were reviewed. Risk of bias was assessed using the ROBINS-I tool. One study met the eligibility criteria. Results are presented in a narrative format as meta-analysis was not possible. This systematic review revealed a lack of evidence on the effectiveness of nutritional education interventions in this high-risk population. Limitations are noted and recommendations have been made.
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Salt sensitivity of blood pressure in childhood and adolescence. Pediatr Nephrol 2022; 37:993-1005. [PMID: 34327584 DOI: 10.1007/s00467-021-05178-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/07/2021] [Accepted: 06/12/2021] [Indexed: 10/20/2022]
Abstract
Although moderation of sodium intake is recommended population-wide, it remains uncertain who benefits from salt restriction. Salt sensitivity refers to changes in blood pressure in response to sodium intake and may occur with or without hypertension. Unfortunately, there is no practical way to assess salt sensitivity in daily practice. Assessment of salt sensitivity even in research studies is challenging with varying protocols utilized which may contribute to differing results. Building on studies in animals and adults, risk factors and conditions associated with salt sensitivity have been identified in the pediatric and young adult populations. This review presents the limited evidence linking obesity, low birth weight, diabetes, chronic kidney disease, and race/ethnicity with salt sensitivity in children, adolescents, and young adults. The impact of stress on sodium handling is also reviewed. The influence of age on the timing of introduction of dietary salt restriction and the long-term influence of salt sensitivity on risk for hypertension are considered. Lastly, interventions other than salt restriction that may improve salt sensitivity and may inform recommendations to families are reviewed.
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Kurtz T, Pravenec M, DiCarlo S. Mechanism-based strategies to prevent salt sensitivity and salt-induced hypertension. Clin Sci (Lond) 2022; 136:599-620. [PMID: 35452099 PMCID: PMC9069470 DOI: 10.1042/cs20210566] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022]
Abstract
High-salt diets are a major cause of hypertension and cardiovascular (CV) disease. Many governments are interested in using food salt reduction programs to reduce the risk for salt-induced increases in blood pressure and CV events. It is assumed that reducing the salt concentration of processed foods will substantially reduce mean salt intake in the general population. However, contrary to expectations, reducing the sodium density of nearly all foods consumed in England by 21% had little or no effect on salt intake in the general population. This may be due to the fact that in England, as in other countries including the U.S.A., mean salt intake is already close to the lower normal physiologic limit for mean salt intake of free-living populations. Thus, mechanism-based strategies for preventing salt-induced increases in blood pressure that do not solely depend on reducing salt intake merit attention. It is now recognized that the initiation of salt-induced increases in blood pressure often involves a combination of normal increases in sodium balance, blood volume and cardiac output together with abnormal vascular resistance responses to increased salt intake. Therefore, preventing either the normal increases in sodium balance and cardiac output, or the abnormal vascular resistance responses to salt, can prevent salt-induced increases in blood pressure. Suboptimal nutrient intake is a common cause of the hemodynamic disturbances mediating salt-induced hypertension. Accordingly, efforts to identify and correct the nutrient deficiencies that promote salt sensitivity hold promise for decreasing population risk of salt-induced hypertension without requiring reductions in salt intake.
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Affiliation(s)
- Theodore W. Kurtz
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94017-0134, U.S.A
| | - Michal Pravenec
- Institute of Physiology, Czech Academy of Sciences, Prague 14220, Czech Republic
| | - Stephen E. DiCarlo
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, U.S.A
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Serum Aldosterone and Urine Electrolytes Dynamics in Response to DASH Diet Intervention – an Inpatient Mechanistic Study. J Clin Transl Sci 2022; 6:e84. [PMID: 35949658 PMCID: PMC9305085 DOI: 10.1017/cts.2022.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Methods: Results: Conclusion:
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Williams EL, Raj SR, Schondorf R, Shen WK, Wieling W, Claydon VE. Salt supplementation in the management of orthostatic intolerance: Vasovagal syncope and postural orthostatic tachycardia syndrome. Auton Neurosci 2021; 237:102906. [PMID: 34823150 DOI: 10.1016/j.autneu.2021.102906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/23/2021] [Accepted: 11/06/2021] [Indexed: 02/07/2023]
Abstract
Salt supplementation is a common non-pharmacological approach to the management of recurrent orthostatic syncope or presyncope, particularly for patients with vasovagal syncope (VVS) or postural orthostatic tachycardia syndrome (POTS), although there is limited consensus on the optimal dosage, formulation and duration of treatment. Accordingly, we reviewed the evidence for the use of salt supplementation to reduce susceptibility to syncope or presyncope in patients with VVS and POTS. We found that short-term (~3 months) salt supplementation improves susceptibility to VVS and associated symptoms, with little effect on supine blood pressure. In patients with VVS, salt supplementation is associated with increases in plasma volume, and an increase in the time taken to provoke a syncopal event during orthostatic tolerance testing, with smaller orthostatic heart rate increases, enhanced peripheral vascular responses to orthostatic stress, and improved cerebral autoregulation. Responses were most pronounced in those with a baseline sodium excretion <170 mmol/day. Salt supplementation also improved symptoms, plasma volume, and orthostatic responses in patients with POTS. Salt supplementation should be considered for individuals with recurrent and troublesome episodes of VVS or POTS without cardiovascular comorbidities, particularly if their typical urinary sodium excretion is low, and their supine blood pressure is not elevated. The efficacy of the response, in terms of the improvement in subjective and objective markers of orthostatic intolerance, and any potential deleterious effect on supine blood pressure, should be routinely monitored in individuals on high salt regimes.
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Affiliation(s)
- E L Williams
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - S R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - R Schondorf
- Department of Neurology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - W K Shen
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - W Wieling
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - V E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.
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Egan BM, Yang J, Rakotz MK, Sutherland SE, Jamerson KA, Wright JT, Ferdinand KC, Wozniak GD. Self-Reported Antihypertensive Medication Class and Temporal Relationship to Treatment Guidelines. Hypertension 2021; 79:338-348. [PMID: 34784722 DOI: 10.1161/hypertensionaha.121.17102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The greater antihypertensive responses to initial therapy with calcium channel blockers (CCBs) or thiazide-type diuretics than renin-angiotensin system blockers as initial therapy in non-Hispanic Black (NHB) adults was recognized in the US High BP guidelines from 1988 to 2003. The 2014 Report from Panel Members Appointed to the Eighth Joint National Committee (2014 aJNC8 Report) and the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline were the first to recommend CCBs or thiazide-type diuretics rather than renin-angiotensin system blockers as initial therapy in NHB. We assessed the temporal relationship of these recommendations on self-reported CCB or thiazide-type diuretics monotherapy by NHB and NHW adults with hypertension absent compelling indications for β-blockers or renin-angiotensin system blockers in National Health and Nutrition Examination Surveys 2015 to 2018 versus 2007 to 2012 (after versus before 2014 aJNC8 Report). CCB or thiazide-type diuretics monotherapy was unchanged in NHW adults (17.1% versus 18.1%, P=0.711) and insignificantly higher after 2014 among NHB adults (43.7% versus 38.2%, P=0.204), although CCB monotherapy increased (29.5% versus 21.0%, P=0.021) and renin-angiotensin system blocker monotherapy fell (44.5% versus 31.0%, P=0.008). Although evidence-based CCB monotherapy increased among NHB adults in 2015 to 2018, hypertension control declined as untreated hypertension and monotherapy increased. While a gap between recommended and actual monotherapy persists, evidence-based monotherapy appears insufficient to improve hypertension control in NHB adults, especially given evidence for worsening therapeutic inertia. Initiating treatment with single-pill combinations and timely therapeutic intensification when required to control hypertension are evidence-based, race-neutral options for improving hypertension control among NHB adults.
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Affiliation(s)
- Brent M Egan
- Improving Health Outcomes, American Medical Association, Greenville, SC (B.M.E., S.E.S.)
| | - Jianing Yang
- Improving Health Outcomes, American Medical Association, Chicago, IL (J.Y., M.K.R., G.D.W.)
| | - Michael K Rakotz
- Improving Health Outcomes, American Medical Association, Chicago, IL (J.Y., M.K.R., G.D.W.)
| | - Susan E Sutherland
- Improving Health Outcomes, American Medical Association, Greenville, SC (B.M.E., S.E.S.)
| | - Kenneth A Jamerson
- Department of Medicine, University of Michigan Medical Center, Ann Arbor (K.A.J.)
| | - Jackson T Wright
- Department of Medicine, Case Western Reserve, Cleveland, OH (J.T.W.)
| | - Keith C Ferdinand
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA (K.C.F.)
| | - Gregory D Wozniak
- Improving Health Outcomes, American Medical Association, Chicago, IL (J.Y., M.K.R., G.D.W.)
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Banerjee T, Sebastian A, Frassetto LA. Diet-dependent acid load associates with mean arterial pressure in a cohort of non-obese, non-black, post-menopausal women. Appl Physiol Nutr Metab 2021; 47:227-233. [PMID: 34614363 DOI: 10.1139/apnm-2020-0928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Higher sodium (Na+) intakes are associated with higher blood pressure (BP). Whether this relationship is stronger with diet-dependent acid load (DAL) and in patients with diagnosed hypertension or normal BP is not well determined. We studied 170 postmenopausal women randomized to potassium bicarbonate or placebo till 36 months where 24-hour urine and arterialized blood were collected. We investigated the association of DAL estimated as urinary potential renal acid load (UPRAL) and mean arterial pressure (MAP) using mixed-effects model, adjusting for age, anthropometrics, creatinine clearance, and treatment. Adjusted regression estimates for change in Na+ and UPRAL on MAP after 12 months follow-up were calculated, and further adjustments were made for change in potassium (K+) and body mass index (BMI). MAP was inversely associated with UPRAL (β [95% CI]:-0.11[-0.25,-0.001]). There was effect modification by hypertension (p-interaction=0.04); MAP decreased significantly in normotensives but the association was not significant in hypertensives. A decrease of 0.70 mmHg in MAP (0.13,1.69) per 50 mmol/24 hr reduction in Na+ was noted when the model was adjusted for change in K+. Our results with UPRAL exhibited stronger dose-response for MAP, which remained significant after adjustment for BMI. UPRAL was independently associated with MAP even after adjustment for potential confounders, and the data showed this association to be more pronounced in normotensives. Novelty: • First longitudinal study on the association of UPRAL and MAP • Association was a more robust relationship than between U[Na/K] ratio and MAP • UPRAL may play a significant role in the pathogenesis of primary hypertension.
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Affiliation(s)
- Tanushree Banerjee
- University of California San Francisco, 8785, Department of Medicine, San Francisco, United States, 94143;
| | - Anthony Sebastian
- University of California San Francisco, 8785, Department of Medicine, San Francisco, United States;
| | - Lynda A Frassetto
- University of California San Francisco Medical Center at Parnassus, 43166, San Francisco, California, United States;
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Dietary sodium and cardiovascular morbidity/mortality: a brief commentary on the 'J-shape hypothesis'. J Hypertens 2021; 39:2335-2343. [PMID: 34326279 DOI: 10.1097/hjh.0000000000002953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The last decade, a growing number of evidence support J-shape or inverse - instead of positive linear -- associations between dietary sodium intake and cardiovascular morbidity/mortality. A careful evaluation of these studies leads to the following observations: less accurate methods for dietary sodium assessment are usually used; most studies included high-risk participants, enhancing the possibility of a 'reverse causality' phenomenon. However, these limitations do not explain all the findings. Few carefully designed randomized clinical trials comparing different levels of sodium intake that address the issue of the optimal and safe range exist; therefore, current guidelines recommend a higher cut-off instead of a safe range of intake. Given the demonstrated harmful effects of very low sodium diets leading to subclinical vascular damage in animal studies, the 'J-shape hypothesis' cannot yet be either neglected or verified. There is a great need of well-designed general population-based prospective randomized clinical trials to address the issue.
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Oyetayo FL, Akomolafe SF, Balogun GB. Effects of Chrysophyllum albidum fruit pulp on haemodynamic parameters, pro-inflammatory markers, antioxidant parameters and critical biomolecules associated with hypertension-in vivo. Inflammopharmacology 2021; 29:825-839. [PMID: 34120250 DOI: 10.1007/s10787-021-00830-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/29/2021] [Indexed: 12/31/2022]
Abstract
The effects of Chrysophyllum albidum fruit pulp on haemodynamic parameters, pro-inflammatory markers, antioxidant parameters and critical biomolecules associated with hypertension in vivo were determined. Feeding with supplemented diet with pulp reduced heart rate, mean arterial pressure, systolic and diastolic blood pressure levels of hypertensive-treated groups. Moreover, hypertensive-treated groups fed with fruit pulp supplemented diets had significantly (p < 0.05) lower level of serum pro-inflammatory markers when compared to untreated hypertensive group. Furthermore, feeding with supplemented diet with pulp and captopril administration reduced AChE, BChE, ACE, and arginase activities of hypertensive-treated groups. The fruit pulp supplemented diet also increased antioxidant status of hypertensive-treated groups. This was supported by the histopathological examination of the kidney and heart tissues. These beneficial effects could in part be the explanations of ethnomedicinal uses of the fruit pulp in the management of hypertension. Nevertheless, the higher percentage inclusion of the pulp showed higher antihypertensive effects.
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Affiliation(s)
- Folake Lucy Oyetayo
- Department of Biochemistry, Faculty of Science, Ekiti State University, Ekiti State, P.M.B. 5363, Ado Ekiti, Nigeria
| | - Seun Funmilola Akomolafe
- Department of Biochemistry, Faculty of Science, Ekiti State University, Ekiti State, P.M.B. 5363, Ado Ekiti, Nigeria.
| | - Gbemisola Beulah Balogun
- Department of Biochemistry, Faculty of Science, Ekiti State University, Ekiti State, P.M.B. 5363, Ado Ekiti, Nigeria
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Impact of dietary intake of sodium and potassium on short-term blood pressure variability. J Hypertens 2021; 39:1835-1843. [PMID: 34054053 DOI: 10.1097/hjh.0000000000002856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Dietary Approaches to Stop Hypertension (DASH)-Sodium trial showed that dietary sodium and potassium affect blood pressure (BP). We aimed to investigate whether dietary sodium and potassium affect short-term BP variability (BPV) in addition to BP. METHODS A total of 343 participants from the DASH-Sodium trial (age 48.4 ± 9.7, 42.5% men) and 323 individuals from the Jackson Heart Study (JHS) (age 56.7 ± 11.2, 30.7% men) with satisfactory ambulatory BP monitoring records and 24-h urine collection were included. Average real variability (ARV) was calculated as a measure of short-term BPV. RESULTS By estimating dietary intake from urinary excretion, we observed that higher urinary sodium-to-potassium ratio was significantly associated with higher diastolic ARV in both studies. Among the DASH-Sodium trial, potassium-rich DASH diet alone had insignificant effect on both systolic (-0.1 ± 1.7 mmHg, P = 0.343) or diastolic ARV (-0.2 ± 1.5 mmHg, P = 0.164), whereas combined DASH diet and low sodium intake significantly reduced both systolic (8.5 ± 1.6 vs. 8.9 ± 1.7 mmHg, P = 0.032) and diastolic ARV (7.5 ± 1.5 vs. 7.8 ± 1.6 mmHg, P = 0.025) as compared with control diet and high sodium intake. As the reduction of systolic ARV was majorly derived from the change of mean SBP, diastolic ARV was significantly determined by urinary sodium-to-potassium ratio (β coefficient ± standard error: 0.012 ± 0.004; P = 0.006) after adjusting for age, sex, smoking, mean DBP, BMI, and race. CONCLUSION Dietary sodium and potassium can jointly modulate short-term BPV in addition to BP. Combined DASH diet and low sodium intake may reduce systolic and diastolic ARV via different mechanisms.
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Kurtz TW, DiCarlo SE, Pravenec M, Morris RC. No evidence of racial disparities in blood pressure salt sensitivity when potassium intake exceeds levels recommended in the US dietary guidelines. Am J Physiol Heart Circ Physiol 2021; 320:H1903-H1918. [PMID: 33797275 DOI: 10.1152/ajpheart.00980.2020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
On average, black individuals are widely believed to be more sensitive than white individuals to blood pressure (BP) effects of changes in salt intake. However, few studies have directly compared the BP effects of changing salt intake in black versus white individuals. In this narrative review, we analyze those studies and note that when potassium intake substantially exceeds the recently recommended US dietary goal of 87 mmol/day, black adults do not appear more sensitive than white adults to BP effects of short-term or long-term increases in salt intake (from an intake ≤50 mmol/day up to 150 mmol/day or more). However, with lower potassium intakes, racial differences in salt sensitivity are observed. Mechanistic studies suggest that racial differences in salt sensitivity are related to differences in vascular resistance responses to changes in salt intake mediated by vasodilator and vasoconstrictor pathways. With respect to cause and prevention of racial disparities in salt sensitivity, it is noteworthy that 1) on average, black individuals consume less potassium than white individuals and 2) consuming supplemental potassium bicarbonate, or potassium rich foods can prevent racial disparities in salt sensitivity. However, the new US dietary guidelines reduced the dietary potassium goal well below the amount associated with preventing racial disparities in salt sensitivity. These observations should motivate research on the impact of the new dietary potassium guidelines on racial disparities in salt sensitivity, the risks and benefits of potassium-containing salt substitutes or supplements, and methods for increasing consumption of foods rich in nutrients that protect against salt-induced hypertension.
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Affiliation(s)
- Theodore W Kurtz
- Department of Laboratory Medicine, University of California, San Francisco, California
| | - Stephen E DiCarlo
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Michal Pravenec
- Institute of Physiology, Czech Academy of Sciences, Prague, Czech Republic
| | - R Curtis Morris
- Department of Medicine, University of California, San Francisco, California
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Canale MP, Noce A, Di Lauro M, Marrone G, Cantelmo M, Cardillo C, Federici M, Di Daniele N, Tesauro M. Gut Dysbiosis and Western Diet in the Pathogenesis of Essential Arterial Hypertension: A Narrative Review. Nutrients 2021; 13:1162. [PMID: 33915885 PMCID: PMC8066853 DOI: 10.3390/nu13041162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/12/2022] Open
Abstract
Metabolic syndrome is a cluster of the most dangerous cardiovascular (CV) risk factors including visceral obesity, insulin resistance, hyperglycemia, alterations in lipid metabolism and arterial hypertension (AH). In particular, AH plays a key role in the complications associated with metabolic syndrome. High salt intake is a well-known risk factor for AH and CV diseases. Vasoconstriction, impaired vasodilation, extracellular volume expansion, inflammation, and an increased sympathetic nervous system (SNS) activity are the mechanisms involved in the pathogenesis of AH, induced by Western diet. Gut dysbiosis in AH is associated with reduction of short chain fatty acid-producing bacteria: acetate, butyrate and propionate, which activate different pathways, causing vasoconstriction, impaired vasodilation, salt and water retention and a consequent high blood pressure. Moreover, increased trimethylamine N-oxide and lipopolysaccharides trigger chronic inflammation, which contributes to endothelial dysfunction and target organs damage. Additionally, a high salt-intake diet impacts negatively on gut microbiota composition. A bidirectional neuronal pathway determines the "brain-gut" axis, which, in turn, influences blood pressure levels. Then, we discuss the possible adjuvant novel treatments related to gut microbiota modulation for AH control.
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Affiliation(s)
- Maria Paola Canale
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (M.P.C.); (M.F.)
| | - Annalisa Noce
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (M.D.L.); (G.M.); (N.D.D.)
| | - Manuela Di Lauro
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (M.D.L.); (G.M.); (N.D.D.)
| | - Giulia Marrone
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (M.D.L.); (G.M.); (N.D.D.)
- PhD School of Applied Medical, Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Maria Cantelmo
- School of Specialization in Geriatrics, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Carmine Cardillo
- Department of Internal Medicine and Geriatrics, Policlinico A. Gemelli IRCCS, 00168 Roma, Italy;
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (M.P.C.); (M.F.)
| | - Nicola Di Daniele
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (M.D.L.); (G.M.); (N.D.D.)
| | - Manfredi Tesauro
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (M.D.L.); (G.M.); (N.D.D.)
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Minamino H, Katsushima M, Hashimoto M, Fujita Y, Yoshida T, Ikeda K, Isomura N, Oguri Y, Yamamoto W, Watanabe R, Murakami K, Murata K, Nishitani K, Tanaka M, Ito H, Ohmura K, Matsuda S, Inagaki N, Morinobu A. Urinary sodium-to-potassium ratio associates with hypertension and current disease activity in patients with rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther 2021; 23:96. [PMID: 33773587 PMCID: PMC8004419 DOI: 10.1186/s13075-021-02479-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/12/2021] [Indexed: 12/21/2022] Open
Abstract
Background Excessive salt intake is thought to exacerbate both development of hypertension and autoimmune diseases in animal models, but the clinical impact of excessive salt in rheumatoid arthritis (RA) patients is still unknown. We performed a cross-sectional study to clarify the associations between salt load index (urinary sodium-to-potassium ratio (Na/K ratio)), current disease activity, and hypertension in an RA population. Methods Three hundred thirty-six participants from our cohort database (KURAMA) were enrolled. We used the spot urine Na/K ratio as a simplified index of salt loading and used the 28-Joint RA Disease Activity Score (DAS28-ESR) as an indicator of current RA disease activity. Using these indicators, we evaluated statistical associations between urinary Na/K ratio, DAS28-ESR, and prevalence of hypertension. Results Urinary Na/K ratio was positively associated with measured systolic and diastolic blood pressure and also with prevalence of hypertension even after covariate adjustment (OR 1.34, p < 0.001). In addition, increased urinary Na/K ratio was significantly and positively correlated with DAS28-ESR in multiple regression analysis (estimate 0.12, p < 0.001), as was also the case in gender-separated and prednisolone-separated sub-analyses. Conclusion Urinary Na/K ratio was independently associated with current disease activity as well as with prevalence of hypertension in RA patients. Thus, dietary modifications such as salt restriction and potassium supplementation should be investigated as a potential candidate for attenuating both disease activity and hypertension in RA patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02479-x.
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Affiliation(s)
- Hiroto Minamino
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan. .,Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan.
| | - Masao Katsushima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan.
| | - Yoshihito Fujita
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan.
| | - Tamami Yoshida
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, Kyoto-shi, Kyoto, 602-8566, Japan
| | - Kaori Ikeda
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Nozomi Isomura
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Yasuo Oguri
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Wataru Yamamoto
- Department of Health Information Management, Kurashiki Sweet Hospital, 3542-1 Nakasho, Krashiki, Okayama, 710-0016, Japan
| | - Ryu Watanabe
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Kosaku Murakami
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Koichi Murata
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Kohei Nishitani
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Hiromu Ito
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
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Lin Z, Wong LYF, Cheung BMY. Diuretic-induced hypokalaemia: an updated review. Postgrad Med J 2021; 98:477-482. [PMID: 33688065 DOI: 10.1136/postgradmedj-2020-139701] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/24/2022]
Abstract
Diuretic-induced hypokalaemia is a common and potentially life-threatening adverse drug reaction in clinical practice. Previous studies revealed a prevalence of 7%-56% of hypokalaemia in patients taking thiazide diuretics. The clinical manifestations of hypokalaemia due to diuretics are non-specific, varying from asymptomatic to fatal arrhythmia. Diagnosis of hypokalaemia is based on the level of serum potassium. ECG is useful in identifying the more severe consequences. A high dosage of diuretics and concomitant use of other drugs that increase the risk of potassium depletion or cardiac arrhythmias can increase the risk of cardiovascular events and mortality. Thiazide-induced potassium depletion may cause dysglycaemia. The risk of thiazide-induced hypokalaemia is higher in women and in black people. Reducing diuretic dose and potassium supplementation are the most direct and effective therapies for hypokalaemia. Combining with a potassium-sparing diuretic or blocker of the renin-angiotensin system also reduces the risk of hypokalaemia. Lowering salt intake and increasing intake of vegetables and fruits help to reduce blood pressure as well as prevent hypokalaemia.
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Affiliation(s)
- Ziying Lin
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Louisa Y F Wong
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Bernard M Y Cheung
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong .,State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, Hong Kong
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37
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Du X, Fang L, Xu J, Chen X, Bai Y, Zhong J. Association between 24-h urinary sodium and potassium excretion and blood pressure among Chinese adults aged 18-69 years. Sci Rep 2021; 11:3474. [PMID: 33568767 PMCID: PMC7876040 DOI: 10.1038/s41598-021-83049-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/27/2021] [Indexed: 01/03/2023] Open
Abstract
The direction and magnitude of the association between sodium and potassium excretion and blood pressure (BP) may differ depending on the characteristics of the study participant or the intake assessment method. Our objective was to assess the relationship between BP, hypertension and 24-h urinary sodium and potassium excretion among Chinese adults. A total of 1424 provincially representative Chinese residents aged 18 to 69 years participated in a cross-sectional survey in 2017 that included demographic data, physical measurements and 24-h urine collection. In this study, the average 24-h urinary sodium and potassium excretion and sodium-to-potassium ratio were 3811.4 mg/day, 1449.3 mg/day, and 4.9, respectively. After multivariable adjustment, each 1000 mg difference in 24-h urinary sodium excretion was significantly associated with systolic BP (0.64 mm Hg; 95% confidence interval [CI] 0.05-1.24) and diastolic BP (0.45 mm Hg; 95% CI 0.08-0.81), and each 1000 mg difference in 24-h urinary potassium excretion was inversely associated with systolic BP (- 3.07 mm Hg; 95% CI - 4.57 to - 1.57) and diastolic BP (- 0.94 mm Hg; 95% CI - 1.87 to - 0.02). The sodium-to-potassium ratio was significantly associated with systolic BP (0.78 mm Hg; 95% CI 0.42-1.13) and diastolic BP (0.31 mm Hg; 95% CI 0.10-0.53) per 1-unit increase. These associations were mainly driven by the hypertensive group. Those with a sodium intake above about 4900 mg/24 h or with a potassium intake below about 1000 mg/24 h had a higher risk of hypertension. At higher but not lower levels of 24-h urinary sodium excretion, potassium can better blunt the sodium-BP relationship. The adjusted odds ratios (ORs) of hypertension in the highest quartile compared with the lowest quartile of excretion were 0.54 (95% CI 0.35-0.84) for potassium and 1.71 (95% CI 1.16-2.51) for the sodium-to-potassium ratio, while the corresponding OR for sodium was not significant (OR, 1.28; 95% CI 0.83-1.98). Our results showed that the sodium intake was significantly associated with BP among hypertensive patients and the inverse association between potassium intake and BP was stronger and involved a larger fraction of the population, especially those with a potassium intake below 1000 mg/24 h should probably increase their potassium intake.
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Affiliation(s)
- Xiaofu Du
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Le Fang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Xiangyu Chen
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Yamin Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Jieming Zhong
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China.
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38
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Higher Intakes of Potassium and Magnesium, but Not Lower Sodium, Reduce Cardiovascular Risk in the Framingham Offspring Study. Nutrients 2021; 13:nu13010269. [PMID: 33477824 PMCID: PMC7832857 DOI: 10.3390/nu13010269] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 11/30/2022] Open
Abstract
We explored the dose-response relations of sodium, potassium, magnesium and calcium with cardiovascular disease (CVD) risk in the Framingham Offspring Study, as well as the combined effects of these minerals. Analyses included 2362 30–64 year-old men and women free of CVD at baseline. Cox proportional-hazards models were used estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for mineral intakes and incident CVD. Cox models with restricted cubic spline functions were used to examine dose-response relations, adjusting for confounding by age, sex, body mass index, dietary fiber intake, and time-varying occurrence of hypertension. Lower sodium intake (<2500 vs. ≥3500 mg/d) was not associated with a lower risk of CVD. In contrast, potassium intake ≥3000 (vs. <2500) mg/d was associated with a 25% lower risk (95% CI: 0.59, 0.95), while magnesium intake ≥320 (vs. <240) mg/d led to a 34% lower risk (95% CI: 0.51, 0.87) of CVD. Calcium intake ≥700 (vs. <500) mg/d was associated with a non-statistically significant 19% lower risk. Restricted cubic spline curves showed inverse dose-response relations of potassium and magnesium with CVD risk, but no such associations were observed for sodium or calcium. These results highlight the importance of potassium and magnesium to cardiovascular health.
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Inflammation and salt in young adults: the African-PREDICT study. Eur J Nutr 2020; 60:873-882. [PMID: 32494865 PMCID: PMC7900065 DOI: 10.1007/s00394-020-02292-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Low-grade inflammation and a diet high in salt are both established risk factors for cardiovascular disease. High potassium (K+) intake was found to counter increase in blood pressure due to high salt intake and may potentially also have protective anti-inflammatory effects. To better understand these interactions under normal physiological conditions, we investigated the relationships between 22 inflammatory mediators with 24-h urinary K+ in young healthy adults stratified by low, medium and high salt intake (salt tertiles). We stratified by ethnicity due to potential salt sensitivity in black populations. METHODS In 991 healthy black (N = 457) and white (N = 534) adults, aged 20-30 years, with complete data for 24-h urinary sodium and K+, we analysed blood samples for 22 inflammatory mediators. RESULTS We found no differences in inflammatory mediators between low-, mid- and high-sodium tertiles in either the black or white groups. In multivariable-adjusted regression analyses in white adults, we found only in the lowest salt tertile that K+ associated negatively with pro-inflammatory mediators, namely interferon gamma, interleukin (IL) -7, IL-12, IL-17A, IL-23 and tumour necrosis factor alpha (all p ≤ 0.046). In the black population, we found no independent associations between K+ and any inflammatory mediator. CONCLUSION In healthy white adults, 24-h urinary K+ associated independently and negatively with specific pro-inflammatory mediators, but only in those with a daily salt intake less than 6.31 g, suggesting K+ to play a protective, anti-inflammatory role in a low-sodium environment. No similar associations were found in young healthy black adults.
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40
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Martens RJH, Henry RMA, Bekers O, Dagnelie PC, van Dongen MCJM, Eussen SJPM, van Greevenbroek M, Kroon AA, Stehouwer CDA, Wesselius A, Meex SJR, Kooman JP. Associations of 24-Hour Urinary Sodium and Potassium Excretion with Cardiac Biomarkers: The Maastricht Study. J Nutr 2020; 150:1413-1424. [PMID: 32386231 DOI: 10.1093/jn/nxaa080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/03/2020] [Accepted: 03/04/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND It is a matter of debate whether sodium and potassium intake are associated with heart disease. Further, the mechanisms underlying associations of sodium and potassium intake with cardiac events, if any, are not fully understood. OBJECTIVES We examined cross-sectional associations of 24-h urinary sodium excretion (UNaE) and potassium excretion (UKE), as estimates of their intakes, with high-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI), and N-terminal pro-B-type natriuretic peptide (NT-proBNP), which are markers of cardiomyocyte injury and cardiac dysfunction. METHODS We included 2961 participants from the population-based Maastricht Study (mean ± SD age 59.8 ± 8.2 y, 51.9% men), who completed the baseline survey between November 2010 and September 2013. Associations were examined with restricted cubic spline linear regression analyses and ordinary linear regression analyses, adjusted for demographics, lifestyle, and cardiovascular disease (CVD) risk factors. RESULTS Median [IQR] 24-h UNaE and UKE were 3.7 [2.8-4.7] g/24 h and 3.0 [2.4-3.6] g/24 h, respectively. After adjustment for potential confounders, 24-h UNaE was not associated with hs-cTnT, hs-cTnI, and NT-proBNP concentrations. In contrast, after adjustment for potential confounders, lower 24-h UKE was nonlinearly associated with higher hs-cTnT and NT-proBNP. For example, as compared with the third/median quintile of 24-h UKE (range: 2.8-3.2 g/24 h), participants in the first quintile (range: 0.5-2.3 g/24 h) had 1.05 (95% CI: 0.99, 1.11) times higher hs-cTnT and 1.14 (95% CI: 1.03, 1.26) times higher NT-proBNP. Associations were similar after further adjustment for estimated glomerular filtration rate, albuminuria, blood pressure, and serum potassium. CONCLUSIONS Twenty-four-hour UNaE was not associated with the studied cardiac biomarkers. In contrast, lower 24-h UKE was nonlinearly associated with higher hs-cTnT and NT-proBNP. This finding supports recommendations to increase potassium intake in the general population. In addition, it suggests that cardiac dysfunction and/or cardiomyocyte injury may underlie previously reported associations of lower potassium intake with CVD mortality.
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Affiliation(s)
- Remy J H Martens
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
| | - Ronald M A Henry
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Otto Bekers
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.,Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Pieter C Dagnelie
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.,Department of Epidemiology, Maastricht University, Maastricht, Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Martien C J M van Dongen
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Simone J P M Eussen
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Marleen van Greevenbroek
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Abraham A Kroon
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Anke Wesselius
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands.,Department of Complex Genetics, Maastricht University, Maastricht, Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, Netherlands
| | - Steven J R Meex
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.,Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jeroen P Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
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41
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Burnier M. Should we eat more potassium to better control blood pressure in hypertension? Nephrol Dial Transplant 2020; 34:184-193. [PMID: 29301002 DOI: 10.1093/ndt/gfx340] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/20/2017] [Indexed: 01/04/2023] Open
Abstract
Changes in lifestyle and nutrition are recommended as the first-step approach to the management of hypertension by all national and international guidelines. Today, when considering nutritional factors in hypertension, almost all the attention is focused on the reduction of salt intake to improve blood pressure (BP) control. Changes in potassium intake are only briefly evoked in guidelines. Few physicians actually think about proposing to eat more foods that are high in potassium (fruits, vegetables, nuts) to better control BP. Yet, during the last 40 years, increasing evidence has accumulated demonstrating that increasing potassium intake, either with food products or with supplements, is associated with significant reductions of both systolic and diastolic BP. The hypotensive effect of potassium is particularly marked in patients with hypertension and in subjects with a very high sodium intake, suggesting that potassium counterbalances the effects of sodium. In addition, several meta-analyses have now confirmed that high potassium intake reduces the risk of stroke by ∼ 25%. Finally, increasing potassium in the diet may perhaps be beneficial for some renal patients, as post hoc analyses have suggested that a high potassium intake may retard the decline of renal function in patients with early chronic kidney disease (CKD) stages. However, high potassium intake may be risky and sometimes even dangerous in hypertensive patients with CKD stages 3-5, specifically diabetics. In this context, however, as the level of evidence remains low, more prospective clinical studies are needed. The goal of this review is to discuss the actual evidence that supports the recommendation to eat more potassium in order to better control BP in essential hypertension and to review the restrictions in CKD patients with hypertension.
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Affiliation(s)
- Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, University Hospital Lausanne, Lausanne, Switzerland
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42
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Eriguchi R, Obi Y, Soohoo M, Rhee CM, Kovesdy CP, Kalantar-Zadeh K, Streja E. Racial and Ethnic Differences in Mortality Associated with Serum Potassium in Incident Peritoneal Dialysis Patients. Am J Nephrol 2019; 50:361-369. [PMID: 31522173 PMCID: PMC6856395 DOI: 10.1159/000502998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/25/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Abnormalities in serum potassium are risk factors for sudden cardiac death and arrhythmias among dialysis patients. Although a previous study in hemodialysis patients has shown that race/ethnicity may impact the relationship between serum potassium and mortality, the relationship remains unclear among peritoneal dialysis (PD) patients where the dynamics of serum potassium is more stable. METHODS Among 17,664 patients who started PD between January 1, 2007 and December 31, 2011 in a large US dialysis organization, we evaluated the association of serum potassium levels with all-cause and arrhythmia-related deaths across race/ethnicity using time-dependent Cox models with adjustments for demographics. We also used restricted cubic spline functions for serum potassium levels to explore non-linear associations. RESULTS Baseline serum potassium levels were the highest among Hispanics (4.2 ± 0.7 mEq/L) and lowest among non-Hispanic blacks (4.0 ± 0.7 mEq/L). Among 2,949 deaths during the follow-up of median 2.2 (interquartile ranges 1.3-3.2) years, 683 (23%) were arrhythmia-related deaths. Overall, both hyperkalemia and hypokalemia (i.e., serum potassium levels >5.0 and <3.5 mEq/L, respectively) were associated with higher all-cause and arrhythmia-related mortality. In a stratified analysis according to race/ethnicity, the association of hypokalemia with all-cause and arrhythmia-related mortality was consistent with an attenuation for arrhythmia-related mortality in non-Hispanic blacks. Hyperkalemia was associated with all-cause and arrhythmia-related mortality in non-Hispanic whites and non-Hispanic blacks, but no association was observed in Hispanics. CONCLUSION Among incident PD patients, hypokalemia was consistently associated with all-cause and arrhythmia-related deaths irrespective of race/ethnicity. However, while hyperkalemia was associated with both death outcomes in non-Hispanic blacks and whites, it was not associated with either death outcome in Hispanic patients. Further studies are needed to demonstrate whether different strategies should be followed for the management of serum potassium levels according to race/ethnicity.
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Affiliation(s)
- Rieko Eriguchi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
- Long Beach Veterans Affairs Healthcare System, Long Beach, California, USA
- Department Epidemiology, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA,
- Long Beach Veterans Affairs Healthcare System, Long Beach, California, USA,
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Petit G, Jury V, Lamballerie M, Duranton F, Pottier L, Martin J. Salt Intake from Processed Meat Products: Benefits, Risks and Evolving Practices. Compr Rev Food Sci Food Saf 2019; 18:1453-1473. [DOI: 10.1111/1541-4337.12478] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Gaëlle Petit
- ONIRIS ‐ Ecole Nationale VétérinaireAgroalimentaire et de l'alimentation Nantes‐Atlantique Rue de la Géraudière, BP 62241 44322 Nantes Cedex France
- GEPEA ‐ Laboratoire de Génie des Procédés ‐ Environnement – Agroalimentaire ‐ MAPS2 ‐ Matrices Aliments Procédés Propriétés Structure – Sensoriel 44322 Nantes Cedex France
| | - Vanessa Jury
- ONIRIS ‐ Ecole Nationale VétérinaireAgroalimentaire et de l'alimentation Nantes‐Atlantique Rue de la Géraudière, BP 62241 44322 Nantes Cedex France
- GEPEA ‐ Laboratoire de Génie des Procédés ‐ Environnement – Agroalimentaire ‐ MAPS2 ‐ Matrices Aliments Procédés Propriétés Structure – Sensoriel 44322 Nantes Cedex France
| | - Marie Lamballerie
- ONIRIS ‐ Ecole Nationale VétérinaireAgroalimentaire et de l'alimentation Nantes‐Atlantique Rue de la Géraudière, BP 62241 44322 Nantes Cedex France
- GEPEA ‐ Laboratoire de Génie des Procédés ‐ Environnement – Agroalimentaire ‐ MAPS2 ‐ Matrices Aliments Procédés Propriétés Structure – Sensoriel 44322 Nantes Cedex France
| | | | - Laurence Pottier
- ONIRIS ‐ Ecole Nationale VétérinaireAgroalimentaire et de l'alimentation Nantes‐Atlantique Rue de la Géraudière, BP 62241 44322 Nantes Cedex France
- GEPEA ‐ Laboratoire de Génie des Procédés ‐ Environnement – Agroalimentaire ‐ MAPS2 ‐ Matrices Aliments Procédés Propriétés Structure – Sensoriel 44322 Nantes Cedex France
| | - Jean‐Luc Martin
- Ifip‐Institut du PorcPôle viandes et charcuteries 7 Avenue du Général de Gaulle 94700 Maisons‐Alfort France
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Association of the spot urine sodium-to-potassium ratio with blood pressure is independent of urinary Na and K levels: The Nagahama study. Hypertens Res 2019; 42:1624-1630. [DOI: 10.1038/s41440-019-0276-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/05/2019] [Accepted: 05/08/2019] [Indexed: 11/08/2022]
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Welte AL, Harpel T, Schumacher J, Barnes JL. Registered dietitian nutritionists and perceptions of liberalizing the hemodialysis diet. Nutr Res Pract 2019; 13:310-315. [PMID: 31388407 PMCID: PMC6669069 DOI: 10.4162/nrp.2019.13.4.310] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/12/2019] [Accepted: 03/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/OBJECTIVES The objective of this study was to assess the level of awareness, comfort, and likelihood of liberalizing the hemodialysis diet in practicing renal registered dietitian nutritionists (RDN). SUBJECTS/METHODS An original, cross-sectional survey was sent to the Academy of Nutrition and Dietetics' Renal Practice Group in May 2017, consisting primarily of renal dietitians. RESULTS A total of 187 renal dietitians responded to the survey designed to assess their current practices regarding the renal diet for hemodialysis patients and how comfortable they would be liberalizing the current restrictions. On average, 16.3% of dietitians are extremely likely to liberalize the restrictions on various food groups including fruits and vegetables, beans and legumes, and whole grains. CONCLUSIONS RDN feel confident in their ability to interpret and apply evidence-based literature into practice, and they are moderately comfortable liberalizing the renal diet. The participants were generally more comfortable liberalizing the phosphorus restriction than the potassium restriction, and the sodium restriction remains important to control interdialytic weight gain and hypertension. Future research is needed to establish efficacy of a liberalized diet as well as interventions to help RDN feel more comfortable implementing a liberalization of the renal diet.
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Affiliation(s)
- Alyssa L Welte
- Department of Family and Consumer Sciences, Illinois State University, Normal, 61790, IL, United States
| | - Tammy Harpel
- Department of Family and Consumer Sciences, Illinois State University, Normal, 61790, IL, United States
| | - Julie Schumacher
- Department of Family and Consumer Sciences, Illinois State University, Normal, 61790, IL, United States
| | - Jennifer L Barnes
- Department of Family and Consumer Sciences, Illinois State University, Normal, 61790, IL, United States
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Effects of High Salt-Low Potassium Diet on Blood Pressure and Vascular Reactivity in Male Sprague Dawley Rats. J Cardiovasc Pharmacol 2019; 71:340-346. [PMID: 29554004 DOI: 10.1097/fjc.0000000000000578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Sodium (Na) intake increases vascular reactivity. Whether low potassium (K) intake affects vascular reactivity-associated blood pressure (BP) changes is uncertain. This study aimed to determine whether Na-induced increases in BP and vascular reactivity are altered by low K intake. Male Sprague Dawley rats were assigned to 3 dietary groups for 6 weeks: a standard Na-K diet (control, n = 12), a high Na-normal K diet (HS-NormK, n = 12), and a high Na-low K diet (HS-LowK, n = 12). BP was measured at baseline and after the dietary intervention. Na and K excretions and vascular reactivity were measured after the dietary intervention. The Na/K ratio was significantly higher in the HS-LowK compared with the other groups. Systolic and diastolic BPs increased significantly in the HS-NormK and HS-LowK groups. In mesenteric arteries, the dose-response curves for phenylephrine-induced contractions shifted to the left and the EC50 (mean ± SD) was significantly lower in the HS-NormK (0.51 ± 0.17 μM, P = 0.003) and HS-LowK (0.69 ± 0.14 μM, P = 0.005) groups compared with the control (3.24 ± 0.79 μM). Systolic (r = -0.58 P = 0.002) and diastolic (r = -0.61 P = 0.001) BPs were associated with the EC50 of phenylephrine-induced contraction in mesenteric arteries. High Na intake induces increased alpha-1 receptor responsiveness in mesenteric arteries, which may be responsible for the increase in BP and is not affected by low dietary K intake.
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O'Donnell M, Mente A, Rangarajan S, McQueen MJ, O'Leary N, Yin L, Liu X, Swaminathan S, Khatib R, Rosengren A, Ferguson J, Smyth A, Lopez-Jaramillo P, Diaz R, Avezum A, Lanas F, Ismail N, Yusoff K, Dans A, Iqbal R, Szuba A, Mohammadifard N, Oguz A, Yusufali AH, Alhabib KF, Kruger IM, Yusuf R, Chifamba J, Yeates K, Dagenais G, Wielgosz A, Lear SA, Teo K, Yusuf S. Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: prospective cohort study. BMJ 2019; 364:l772. [PMID: 30867146 PMCID: PMC6415648 DOI: 10.1136/bmj.l772] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (<2.0 g sodium, >3.5 g potassium) in adults. DESIGN International prospective cohort study. SETTING 18 high, middle, and low income countries, sampled from urban and rural communities. PARTICIPANTS 103 570 people who provided morning fasting urine samples. MAIN OUTCOME MEASURES Association of estimated 24 hour urinary sodium and potassium excretion (surrogates for intake) with all cause mortality and major cardiovascular events, using multivariable Cox regression. A six category variable for joint sodium and potassium was generated: sodium excretion (low (<3 g/day), moderate (3-5 g/day), and high (>5 g/day) sodium intakes) by potassium excretion (greater/equal or less than median 2.1 g/day). RESULTS Mean estimated sodium and potassium urinary excretion were 4.93 g/day and 2.12 g/day, respectively. After a median follow-up of 8.2 years, 7884 (6.1%) participants had died or experienced a major cardiovascular event. Increasing urinary sodium excretion was positively associated with increasing potassium excretion (unadjusted r=0.34), and only 0.002% had a concomitant urinary excretion of <2.0 g/day of sodium and >3.5 g/day of potassium. A J-shaped association was observed of sodium excretion and inverse association of potassium excretion with death and cardiovascular events. For joint sodium and potassium excretion categories, the lowest risk of death and cardiovascular events occurred in the group with moderate sodium excretion (3-5 g/day) and higher potassium excretion (21.9% of cohort). Compared with this reference group, the combinations of low potassium with low sodium excretion (hazard ratio 1.23, 1.11 to 1.37; 7.4% of cohort) and low potassium with high sodium excretion (1.21, 1.11 to 1.32; 13.8% of cohort) were associated with the highest risk, followed by low sodium excretion (1.19, 1.02 to 1.38; 3.3% of cohort) and high sodium excretion (1.10, 1.02 to 1.18; 29.6% of cohort) among those with potassium excretion greater than the median. Higher potassium excretion attenuated the increased cardiovascular risk associated with high sodium excretion (P for interaction=0.007). CONCLUSIONS These findings suggest that the simultaneous target of low sodium intake (<2 g/day) with high potassium intake (>3.5 g/day) is extremely uncommon. Combined moderate sodium intake (3-5 g/day) with high potassium intake is associated with the lowest risk of mortality and cardiovascular events.
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Affiliation(s)
- Martin O'Donnell
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
- HRB-Clinical Research Facility, Galway University Hospital, NUI Galway, Galway, Ireland
| | - Andrew Mente
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
| | - Matthew J McQueen
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
| | - Neil O'Leary
- HRB-Clinical Research Facility, Galway University Hospital, NUI Galway, Galway, Ireland
| | - Lu Yin
- Medical Research & Biometrics Centre, National Centre for Cardiovascular Diseases Cardiovascular, Fengcunxili, Mentougou District, Beijing, China
| | - Xiaoyun Liu
- Medical Research & Biometrics Centre, National Centre for Cardiovascular Diseases Cardiovascular, Fengcunxili, Mentougou District, Beijing, China
| | - Sumathi Swaminathan
- Division of Nutrition, St John's Research Institute, Bangalore, Karnataka, India
| | - Rasha Khatib
- Departments of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - John Ferguson
- HRB-Clinical Research Facility, Galway University Hospital, NUI Galway, Galway, Ireland
| | - Andrew Smyth
- HRB-Clinical Research Facility, Galway University Hospital, NUI Galway, Galway, Ireland
| | - Patricio Lopez-Jaramillo
- Fundacion Oftalmologica de Santander (FOSCAL), Medical School, Universidad de Santander, Floridablanca-Santander, Colombia
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica ECLA, Instituto Cardiovascular de Rosario, Rosario, Santa Fe, Argentina
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | | | - Noorhassim Ismail
- Department of Community Health. University Kebangsaan Malaysia Medical Centre, Malaysia
| | - Khalid Yusoff
- Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Antonio Dans
- University of the Philippines-Manila, Ermita, Manila, Philippines
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Andrzej Szuba
- Division of Angiology, Wroclaw Medical University, Wroclaw, Poland
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atyekin Oguz
- Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Afzal Hussein Yusufali
- Hatta Hospital, Dubai Medical University, Dubai Health Authority. Dubai, United Arab Emirates
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Centre, College of Medicine, King Saud University. Riyadh, Saudi Arabia
| | - Iolanthe M Kruger
- Faculty of Health Science, North-West University, Potchefstroom campus, Potchefstroom, South Africa
| | - Rita Yusuf
- School of Life Sciences and The Centre for Health, Population and Development. Independent University, Bangladesh, Dhaka, Bangladesh
| | - Jephat Chifamba
- University of Zimbabwe, College of Health Sciences, Physiology Department, Harare, Zimbabwe
| | - Karen Yeates
- Department of Medicine, Division of Nephrology, Queen's University, Kingston, Canada
| | - Gilles Dagenais
- Laval University Heart and Lungs Institute, Quebec City, QC, Canada
| | | | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, and Division of Cardiology, Providence Health Care, BC, Canada
| | - Koon Teo
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
| | - Salim Yusuf
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
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48
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Sodium sensitivity of blood pressure in Chinese populations. J Hum Hypertens 2019; 34:94-107. [PMID: 30631129 DOI: 10.1038/s41371-018-0152-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/15/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
Abstract
Hypertension is an enormous public-health challenge in the world due to its high prevalence and consequent increased cardiovascular disease morbidity and mortality. Observational epidemiologic studies and clinical trials have demonstrated a causal relationship between sodium intake and elevated blood pressure (BP). However, BP changes in response to sodium intervention vary among individuals-a trait called sodium sensitivity. This paper aims to review the recent advances in sodium-sensitivity research in Chinese and other populations. Older age, female gender, and black race are associated with high sodium sensitivity. Both genetic and environmental factors influence BP sodium sensitivity. Physical activity and dietary potassium intake are associated with reduced sodium sensitivity while obesity, metabolic syndrome, and elevated BP are associated with increased sodium sensitivity. Familial studies have documented a moderate heritability of sodium sensitivity. Candidate gene association studies, genome-wide association studies, whole-exome, and whole-genome sequencing studies have been conducted to elucidate the genomic mechanisms of sodium sensitivity. The Genetic Epidemiology Network of Salt Sensitivity (GenSalt) study, the largest family-based feeding study to date, was conducted among 1906 Han Chinese in rural northern China. This study showed that ~32.4% of Chinese adults were sodium sensitive. Additionally, several genetic variants were found to be associated with sodium sensitivity. Findings from the GenSalt Study and others indicate that sodium sensitivity is a reproducible trait and both lifestyle factors and genetic variants play a role in this complex trait. Discovering biomarkers and underlying mechanisms for sodium sensitivity will help to develop individualized intervention strategies for hypertension.
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49
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Nguyen-Huynh MN, Young JD, Alexeeff S, Hatfield MK, Sidney S. Shake Rattle & Roll - Design and rationale for a pragmatic trial to improve blood pressure control among blacks with persistent hypertension. Contemp Clin Trials 2019; 76:85-92. [PMID: 30500558 DOI: 10.1016/j.cct.2018.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND In Kaiser Permanente Northern California (KPNC), members had similar access to care and a very high overall rate of hypertension control. However, blacks had poorer blood pressure (BP) control than whites. The Shake Rattle & Roll (SRR) trial aimed to improve BP control rates in blacks and to reduce disparities in hypertension control. METHODS SRR was a cluster randomized controlled trial conducted at an urban medical center. All 98 adult primary care physicians (PCP) and their panels of hypertensive black patients were randomized, stratified by panel size, to one of three arms: 1) Usual Care (n = 33 PCPs, N = 1129 patients); 2) Enhanced Monitoring arm with an emphasis on improving pharmacotherapy protocol adherence (n = 34 PCPs, N = 349 patients); or 3) Lifestyle arm with a culturally tailored diet and lifestyle coaching intervention focusing on the Dietary Approaches to Stop Hypertension eating plan (n = 31 PCPs, N = 286 patients). The intervention period was for 12-months post-enrollment. Follow-up was planned for one and three years post-intervention completion. Primary outcome measure was the proportion of participants with controlled BP, defined as <140/90 mmHg, at 12-months post-enrollment. Secondary outcome included adverse cardiovascular events. An intention-to-treat analysis was carried out as the primary analysis. CONCLUSION SRR was a uniquely designed trial that included components from both pragmatic and explanatory methods. The pragmatic aspects allow for a more cost-effective way to conduct a clinical trial and easier implementation of successful interventions into clinical practice. However, there were also challenges of having mixed methodology with regards to trial conduction and analysis.
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Affiliation(s)
- Mai N Nguyen-Huynh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Neurology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA, USA.
| | - Joseph D Young
- Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Meghan K Hatfield
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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50
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Thi Minh Nguyen T, Miura K, Tanaka-Mizuno S, Tanaka T, Nakamura Y, Fujiyoshi A, Kadota A, Tamaki J, Takebayashi T, Okamura T, Ueshima H. Association of blood pressure with estimates of 24-h urinary sodium and potassium excretion from repeated single-spot urine samples. Hypertens Res 2018; 42:411-418. [PMID: 30523292 DOI: 10.1038/s41440-018-0152-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/26/2018] [Accepted: 06/10/2018] [Indexed: 02/07/2023]
Abstract
While the association between 24-h urinary sodium and potassium excretion with blood pressure is well established, the relationships of these ions to spot urine measurements are unclear. Our purpose is to assess the association between blood pressure and the estimated 24-h sodium and potassium excretion from repeated single-spot urine samples. Spot urine and blood pressure were collected annually during a 5-year period from 4360 Japanese workers with ages ranging from 19 to 55 years. Estimates of 24-h sodium and potassium excretion were based on Tanaka's formula. Overall, a single standard deviation increase in the estimated sodium excretion (36.5 mmol/day) was associated with a 1.3 mmHg higher systolic blood pressure and a 0.8 mmHg higher diastolic blood pressure (P < 0.001). A single standard deviation increase in estimated potassium excretion (8.9 mmol/day) was associated with a 1.1 mmHg lower systolic blood pressure and a 0.7 mmHg lower diastolic blood pressure (P < 0.001). As a combined measure of the excretion of both electrolytes, the estimated 24-h sodium-to-potassium ratio was positively associated with both blood pressures (P < 0.001). Associations of blood pressure with sodium and the sodium-to-potassium ratio increased with age and were stronger in men compared to women. Associations with potassium and the sodium-to-potassium ratio were stronger in individuals who were overweight. The findings provide evidence for an association between blood pressure and the estimated 24-h sodium and potassium excretion from repeated single-spot urine samples. As convenient measures of dietary intake for each electrolyte, repeated spot urine samples may be useful for assessing hypertension risk, especially in men, older individuals, and overweight individuals.
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Affiliation(s)
- Trang Thi Minh Nguyen
- Department of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan. .,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan.
| | | | | | - Yasuyuki Nakamura
- Department of Food Science and Human Nutrition, Ryukoku University, Otsu, Japan
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Junko Tamaki
- Department of Hygiene and Public Health, Osaka Medical University, Takatsuki, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
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