A new test showing abnormal net Na+ and K+ fluxes in erythrocytes of essential hypertensive patients

The role of salt in hypertension

Epidemiological data indicate a weak but significant positive correlation between the level of salt intake and blood pressure. It is unclear how this relationship is mediated but some studies indicate that heredity for hypertension is associated with an increased sensitivity to salt. Decrease of the salt intake decreases blood pressure in established hypertension and should be used as a therapeutic adjuvant in mild uncomplicated hypertension much more often than is now the case. Increased salt intake in young subjects with or without heredity for hypertension does not seem to increase the blood pressure during a 4-12 week load. Increased salt intake in middle-aged men, on the other hand, seem to induce a blood pressure increase irrespective of the presence or absence of a positive family history. The sensitivity to a high salt intake might thus be associated with aging. Increase of the salt intake from the normal level seems to induce an increase in sympathetic nervous activity. The interplay between the level of salt intake and sympathetic nervous activity should be studied in more detail.

Erythrocyte and total body potassium in untreated primary hypertension

In a study of total body and erythrocyte potassium in mild hypertension we found decreased intracellular potassium concentrations in 41 hypertensives compared to controls but no correlation between intracellular potassium, measured by whole body counting, and erythrocyte potassium. A total body potassium corresponding to an intracellular potassium of 85% or less of the expected value was found in females. In the hypertensives, a negative correlation existed between serum and erythrocyte potassium. No correlation was found between potassium decrease and urinary aldosterone or plasma renin level. An inhibition of the active sodium-potassium exchange at the cellular level is proposed as an explanation of these findings.

Low-dose dexamethasone in the rat: a model to study insulin resistance

The main aim of this study was to set up a new animal model to study insulin resistance. Wistar rats (6 or 7 per group) received the following for 4 wk in experiment 1: 1) vehicle, 2) 2 microg/day subcutaneous dexamethasone, 3) metformin (400 mg x kg(-1) x day(-1) os), and 4) dexamethasone plus metformin. In experiment 2 the rats received the following: 1) vehicle, 2) dexamethasone, 3) dexamethasone plus arginine (2%; as substrate of the nitric oxide synthase for nitric oxide production) in tap water, and 4) dexamethasone plus isosorbide dinitrate (70 mg/kg; as direct nitric oxide donor) in tap water. Insulin sensitivity was significantly reduced by dexamethasone already at week 1, before the increase in blood pressure (day 15) and without significant changes in body weight compared with vehicle. Dexamethasone-treated rats had significantly higher triglycerides, hematocrit, and insulin, whereas serum total nitrates/ nitrites were lower compared with vehicle. The concomitant treatment with metformin minimized all the described effects of dexamethasone. In experiment 2, only isosorbide dinitrate was able to prevent the observed dexamethasone-induced metabolic, hemodynamic, and insulin sensitivity changes. Chronic low-dose subcutaneous dexamethasone (2 microg/day) is a useful model to study the relationships between insulin resistance and blood pressure in the rat, and dexamethasone might decrease insulin sensitivity and increase blood pressure through an endothelium-mediated mechanism.

Normal erythrocyte calpain I activity on membrane proteins under near-physiological conditions in patients with essential hypertension

CONTEXT

It has been reported that the equilibrium between the erythrocyte protease calpain I and its physiological inhibitor calpastatin is disrupted in patients with essential hypertension.

OBJECTIVE

To investigate the activity of non-purified calpain I in hemolysates against the erythrocytic membrane proteins, rather than against other substrates.

DESIGN

Evaluation of calpain I red cell activity upon its own physiological substrates in hypertensive patients, in a near-physiological environment.

SETTING

LIM-23 and LIM-40 of Hospital das Clinicas of the Faculty of Medicine of USP.

SAMPLE

Patients with moderate primary hypertension over 21 years of age who were given amlodipine (n:10) and captopril (n:10) for 8 weeks, plus normal controls (n:10).

MAIN MEASUREMENTS

Red cell membrane proteins were incubated with and without protease inhibitors and with and without calcium chloride and underwent polyacrylamide gel electrophoresis.

RESULTS

Digestion of bands 2.1 and 4.1 was observed, indicating calpain I activity. No statistical differences regarding bands 2.1 and 4.1 were observed before treatment, between the controls and the hypertensive patients, either in ghosts prepared without calcium or with increasing concentrations of calcium. Nor were statistical differences observed after treatment, between the controls and the patients treated with amlodipine and captopril, or between the patients before and after treatment with both drugs.

CONCLUSION

The final activity of non-purified calpain I upon its own physiological substrate, which was the approach utilized in this study, may more adequately reflect what happens in red cells. Under such conditions no imbalance favoring calpain I activity increase was observed. The protective factor provided by calpastatin against calpain I activity may diminish under hypertension.

The effect of hypertension on the response to blood loss in a rodent model

OBJECTIVE

Hypertensive patients having higher baseline peripheral resistance and sympathetic tone than normotensive patients may have aberrant responses to hemorrhage. In an attempt to further characterize this clinical observation, the authors compared the hemodynamic and metabolic responses to hemorrhage between spontaneously hypertensive rats (SHR) and normotensive rats (NTR).

METHODS

Twenty adult rats (10 NTR and 10 SHR) were anesthetized with althesin via the intraperitoneal route. Femoral arteries were cannulated by cutdown. Twelve (6 SHR and 6 NTR) rats underwent controlled catheter hemorrhage of 25% of their total blood volumes. Eight rats (4 SHR and 4 NTR) served as nonhemorrhage controls. Mean arterial pressure (MAP) and base excess (BE) were measured prehemorrhage and then every 15 minutes for the next 120 minutes. Data were reported as mean +/- standard error of the mean (SEM). Group comparisons were analyzed by ANOVA with repeated values post-hoc by Bonferroni. Statistical significance was defined by an alpha = 0.05.

RESULTS

Immediately after hemorrhage, the SHR group experienced a significantly (p < 0.001) greater drop in MAP of 70 +/- 4% in the SHR vs 40 +/- 6% in the NTR. Blood pressure in the NTR returned to control values 15 minutes after hemorrhage, but the SHR remained relatively hypotensive for the entire length of the experiment. Base excess in the SHR decreased significantly (p < 0.004) by 8.2 +/- 2 mmol/L from control values, as compared with no changes in BE for the NTR.

CONCLUSIONS

The authors observed significant differences in the response to hemorrhage between hypertensive and normotensive rats. Hypertensive rats experienced a more profound hemorrhagic shock insult than normotensives for the same degree of blood loss.

Determination of potassium flux activity of viable human erythrocytes by measuring the release-influx ratio

A simple and convenient method to determine the K+-flux activity of viable human erythrocytes was developed. Erythrocyte suspensions were incubated at 4 degrees C for 24 h to induce K+-release (deltaKr) and then at 37 degrees C for 3 h to influx K+ into erythrocytes (deltaKi). A straight-line relationship between K+ release-influx ratio and ouabain-induced K+-efflux from erythrocytes indicated that deltaKi/deltaKr ratio or the K+-flux activity was reflected predominantly by Na+/K+-exchanging ATPase activity. Using this method, K+-flux activity of erythrocytes in the young and the aged subjects was measured. The mean deltaKi/deltaKr ratio of the aged subjects was decreased significantly. This method of measuring deltaKi/deltaKr ratio is useful for the evaluation of K+-flux activity of viable erythrocytes.

The relationship between the intrauterine environment and blood pressure in 3-year-old Japanese children

In 195 Japanese children the systolic pressure at 3 years of age was inversely correlated to the body weight at birth and positively correlated to the mothers' systolic pressure during pregnancy: the average systolic pressure in children whose body weight at birth exceeded 3510 g was 3.0 mmHg, which was lower than that of children whose body weight at birth was 2990 g or less. There was an increase of 0.12 mmHg in the children's systolic pressure with each increment of 1 mmHg in the systolic pressure of their mothers. The systolic pressure at 3 years in children of mothers who had had pretibial oedema during pregnancy (101.0 +/- 8.8 mmHg) was significantly higher compared with children whose mothers did not have oedema (96.6 +/- 9.6 mmHg).

Alterations in sodium metabolism as an etiological model for hypertension

An adequate matching for race, sex, stage of the menstrual cycle, family history of hypertension, and the amount of sodium and other electrolytes in the diet should be a prerequisite for valid conclusions when interpreting the erythrocyte concentration and fluxes of sodium in essential hypertensive patients in comparison with normal subjects. Alterations in intracellular sodium concentration and transmembrane sodium transport systems as causes of essential hypertension are postulated. This review article describes how this abnormal sodium and calcium metabolism translates into increased systemic vascular resistance through altered vasoactive responses and/or vasculature structural changes.

A pilot study of erythrocyte lithium-sodium countertransport in women during the menstrual cycle

OBJECTIVE

The study investigated lithium-sodium countertransport in erythrocytes of normal female volunteers during different phases of the menstrual cycle or during administration of oral contraceptives.

METHODS

Ten normally menstruating, and eight oral contraceptive using, normal female subjects were studied over at least one cycle. Erythrocyte lithium-sodium countertransport was determined using. standard, previously validated methods at different phases of the menstrual cycle. Hematological, electrolyte, blood pressure and other transport measures were also made and these were related to the self-reported incidence of premenstrual symptomatology.

RESULTS

A correlation, (p < 0.02), was found between lithium-sodium countertransport rate and the premenstrual symptom severity score but only in the premenstrual phase. There was no correlation between any of the electrolyte, blood pressure or hematological data and lithium-sodium countertransport rate nor between it and other ion transport measures. Pre-menstrual symptomatology was conspicuously absent from those subjects taking oral contraceptives. Cyclical fluctuations in normally menstruating women, and differences between them and oral contraceptive users, were seen in lithium-sodium countertransport rate although the groups were too small to show statistical significance.

CONCLUSIONS

Care was taken to exclude influences due to circadian, dietary and diurnal variations and the present results show somewhat less within-individual variability in erythrocyte lithium-sodium countertransport during the menstrual cycle than do other reports in the literature. Some interesting features were observed which justify a much larger scale study than the present pilot experiment which should involve a larger number of subjects studied over more than one cycle and in particular a more detailed study of the ovulatory phase.

Sodium-lithium countertransport and family history of hypertension in childhood

We have studied the relationship between sodium-lithium countertransport, determined in childhood, and family history of hypertension. Countertransport was measured in healthy children and those with secondary hypertension. There was no significant difference in countertransport between these two groups. In the normal children (n = 52, median age 6.8 years), there was a positive relationship between body mass index and countertransport (rs = 0.34, p < 0.02). A positive relationship between family history of hypertension using a ranked scoring system, and countertransport, not related to age, body mass or blood pressure (n = 34, rs = 0.63, p < 0.001) was also found. There was no significant relationship between intracellular sodium concentration and countertransport. These data confirm that countertransport in normal children is related to body mass index and indicate that a genetic predisposition to primary hypertension marked by sodium-lithium countertransport is identifiable in childhood.

Altered erythrocyte transmembrane transport of sodium and potassium in patients with conventional or reservoir ileostomy

After proctocolectomy, the loss of the colonic absorptive capacity of sodium is compensated for by increased small intestine sodium absorption and renal conservation of Na by enhanced tubular reabsorption. These processes entail increased cellular sodium transport in the enterocytes and in the renal tubular cells. In order to evaluate if there is a general increase in cellular transport of Na after proctocolectomy for inflammatory bowel diseases erythrocyte Na and K contents and the transmembrane Na fluxes were determined in 35 patients with conventional ileostomy, 23 of which were reinvestigated after conversion to continent reservoir ileostomy. A selected group of another 12 patients having high output from their reservoir ileostomy and low urinary Na were studied concomitantly and 33 healthy subjects served as controls. The intracellular Na content did not differ between the groups while the intracellular K levels were higher in patients with conventional or continent ileostomy compared to controls. In addition, the Na influx and the efflux rate constant of Na were both increased after conversion to reservoir ileostomy. Na influx correlated positively with intake and urinary excretion of Na in conventional ileostomy patients. The results suggest that patients with ileostomy have an increased cellular K uptake and that construction of a reservoir ileostomy further alters cell cation transport by increasing the transmembrane Na turnover.

Erythrocyte transmembrane Na and K fluxes in pseudohypoaldosteronism

Pseudohypoaldosteronism (PHA) is a disease characterized by hyponatremia, hypotension, and dehydratation, despite the presence of hyperreninemic hyperaldosteronism. The membrane-bound Na,K ATPase activity and the transmembrane Na and K transport systems have been studied in vitro in red blood cells of two subjects, son and mother, affected by pseudohypoaldosteronism with different degrees of clinical involvement. Both parameters were significantly altered suggesting that the refractory response to mineralocorticoids is detectable, not only in kidneys and salivary and sweat glands, but also in red blood cells. Since pseudohypoaldosteronism, in its asymptomatic form, may be much more common than expected, we suggest the use of the tests described herein as a practical approach to the early diagnosis of pseudohypoaldosteronism in the investigation of sodium wasting syndromes.

Pregnancy induced hypertension and sodium pump function in erythrocytes

OBJECTIVE

To determine if erythrocyte sodium pump function is altered with the onset of pregnancy induced hypertension.

DESIGN

A prospective descriptive study.

SUBJECTS

Thirty-two primigravid women with pregnancy-induced hypertension (17 had proteinuria) and 32 gestation-matched normotensive primigravid pregnant women were studied and measurements repeated 20 weeks after delivery.

INTERVENTION

Erythrocyte sodium, ouabain-sensitive sodium flux and the sodium pump rate constant were measured in whole blood and the maximum velocity and sodium affinity of the sodium pump were measured in vitro.

RESULTS

Blood pressure remained higher after delivery in the women who had been hypertensive during pregnancy. In normal pregnancy erythrocyte sodium was decreased, and ouabain-sensitive sodium flux, the sodium pump rate constant and maximum velocity (Vmax) were increased compared with 20 weeks after delivery. In pregnancy-induced hypertension erythrocyte sodium and sodium pump changes were the same as in normal pregnancy. The possibility of a positive association between changes in erythrocyte sodium and in blood pressure was excluded. The rate constant of the sodium pump in blood was related to its Vmax measured in vitro but the relation had greater variance in the hypertensives with 7 of the 32 women having rate constants greater than expected from their Vmax.

CONCLUSION

There was no evidence of sodium pump inhibition or a rise in intracellular sodium associated with increased blood pressure in pregnancy. There may have been stimulation of the sodium pump by a plasma factor in some hypertensive women.

Erythrocyte sodium transport at twenty-year follow-up of childhood hypertension

Twelve-hour urinary sodium excretion, the number of sodium pump sites (Bmax) and the Na/K flux ratio in erythrocytes were measured in 13 previously diagnosed hypertensive subjects. At the time of the study, six subjects were still hypertensive and showed a significantly lower Na/K flux ratio in erythrocytes than the remaining seven subjects who were normotensive. Bmax was also lower in the hypertensive group compared to the normotensive group, although this was not statistically significant. Urinary Na excretion did not show any significant difference between the two groups. These findings suggest that a cell membrane sodium transport defect may have a role in the development of essential hypertension in adult life.

Erythropoietin induced transmembrane calcium influx in essential hypertension

The effects of erythropoietin (EPO) on cytosolic free calcium concentration ([Ca2+]i) in platelets of 20 essential hypertensive patients (HT) and of 25 normotensive subjects (NT) were investigated using the fura2 technique. In resting platelets [Ca2+]i were not significantly higher in HT compared to NT (74.3 +/- 7.8 nM vs 59.8 +/- 7.0 nM, mean +/- SEM). Addition of EPO significantly increased [Ca2+]i in HT compared to NT (13.8 +/- 5.3 nM vs 0.9 +/- 1.9 nM, p less than 0.01). EPO increased the amount of calcium in intracellular stores. This was confirmed independently using thrombin-induced changes of [Ca2+]i in a calcium-free medium and using chlorotetracycline as a marker of stored calcium. After preincubation with EPO thrombin-induced changes of [Ca2+]i were significantly lower in HT compared to NT (306.1 +/- 30.0 nM vs 407.7 +/- 35.7 nM, p less than 0.05). In a calcium-free medium after preincubation with EPO thrombin-induced changes of [Ca2+]i were significantly lower in HT compared to NT (54.7 +/- 11.8 nM vs 100.9 +/- 10.5 nM, p less than 0.05) indicating lower storage capacity in HT. It is concluded that elevated response to EPO may provide a powerful tool to evaluate diagnosis and underlying pathophysiological mechanisms in essential hypertension.

Erythrocyte sodium-lithium countertransport in Chinese: its relationship to family history of hypertension

Rates of sodium (Na+)-stimulated lithium (Li+) efflux (Na(+)-Li+ countertransport) and ouabain-sensitive Na+ efflux (Na+ pump) were determined in erythrocytes of Chinese normotensive and hypertensive subjects. Near-maximal rate of Na(+)-Li+ countertransport was found to be significantly higher in hypertensive than normotensive subjects. No significant difference was observed for the rate of Na+ pump between them. A second series of study involved normotensive subjects without and with hypertensive parent(s) (group A and B, respectively) and hypertensive subjects (group C). We found that the rate of Na(+)-Li+ countertransport in group A was significantly lower than that of group B and C, while no difference existed between group B and C. No significant difference was observed for the rate of Na+ pump among the three groups. Our results suggested that Na(+)-Li+ countertransport activity could be a genetic marker for essential hypertension in Chinese, similar to that as proposed in Caucasians.

High blood pressure: Hunting the genes

High blood pressure is a disease of unknown cause. Family history of the disease indicates higher risk, but it is not known which genes are involved or how they interact with environmental influences to produce the disorder. Molecular biology offers an approach to problems that have not so far been solved by classical physiology or biochemistry. By analysing polymorphic variation in chromosome markers such as minisatellite sequences, or by restriction fragment polymorphism analysis of candidate genes, attempts are being made to link genetic variations with hypertension. In genetically hypertensive rats, hypertension is associated with a polymorphism of the renin gene and with other loci on chromosomes 10 and 18. The role of these loci in human hypertension remains to be determined. Other genes such as sodium-lithium countertransport may be involved. Environmental factors such as stress or salt intake could influence the rate or timing of expression of certain genes and thus result in hypertension.

Sodium metabolism in offspring of hypertensive parents

Intracellular sodium concentration and Na+/K(+)-ATPase activity were studied in erythrocytes obtained from members of 14 families with one hypertensive parent and from age-matched control subjects, as part of a study on the genetic and environmental determinants of essential hypertension. We found reduced Na+/K(+)-ATPase activity, increased intracellular Na+ concentration, and reduced urinary Na+ excretion in hypertensive patients as compared with the control subjects. In the offspring of hypertensive parents an increase in intracellular Na+ concentration and a decrease in Na+/K(+)-ATPase activity were observed, with a significant correlation relating such parameters. Normotensive spouses did not differ from the normotensive control adults in any of the parameters studied, suggesting no influence of shared family environment in our family group. These data suggest that there is a strong genetic influence contributing to familiar alterations in cation transport, although long-term studies are needed to evaluate the influence of environmental determinants.

Serum insulin, insulin sensitivity, and erythrocyte sodium metabolism in normotensive and essential hypertensive subjects with and without overweight

Increased insulin circulating levels and perturbations of intracellular sodium metabolism have been reported in essential hypertensive patients, leading to postulate their involvement in the pathophysiology of the disease. In-vitro studies have shown that insulin modulates the activity of some transmembrane sodium transporters. The aim of this investigation was to assess in subjects with essential hypertension and/or overweight, the levels of fasting serum insulin, the activity of sodium transporters and their possible relationships. In 18 lean normotensive, 12 overweight normotensive, 18 untreated lean essential hypertensive, and 16 untreated overweight essential hypertensive subjects, we measured the fasting levels of blood glucose and serum insulin, and calculated the glucose/insulin ratio as an index of sensitivity to insulin. In addition, in the red blood cells of these subjects, we evaluated the maximal rate of ouabain-sensitive Na/K pump, furosemide-sensitive outward Na/K cotransport, Nai/Lio countertransport, and the constant rate of passive permeability to Na. When compared to lean normotensive, overweight normotensive, lean hypertensive, and overweight hypertensive subjects exhibited significantly higher fasting insulin levels, with lower glucose/insulin ratio. No significant difference was found in the activity of Na/K pump, Na/K cotransport, and passive permeability to Na. The Nai/Lio exchange was significantly increased in both hypertensive groups. Mean blood pressure correlated positively and independently with body mass index and fasting insulinemia, and inversely with the glucose/insulin ratio. No relationships were found between blood pressure, fasting insulin levels or glucose/insulin ratio and the activity of sodium transport systems. We conclude that hyperinsulinemia and insulin resistance are associated with essential hypertension independently of overweight. These data lend support to the hypothesis that insulin is involved, concurrently with other factors, in the pathogenesis of essential hypertension in both lean and obese subjects.

Diuretic effect of bumetanide in isolated perfused kidneys of Milan hypertensive rats

The Milan hypertensive strain of rats (MHS) is characterized in the prehypertensive phase (4 weeks of age) by a significantly faster bumetanide-sensitive cell membrane Na+,K+,Cl(-)-cotransport as compared to matched normotensive controls (MNS). The isolated kidney preparation, which allows the study of renal function under controlled in vitro conditions, was chosen to compare the natriuretic effect of the loop diuretic, bumetanide, to that of two other diuretics (amiloride and hydrocholorothiazide) acting on different parts of the nephron. Concentrations ranging from 10(-7) to 10(-4) M were tested in 4-week-old MHS and MNS. Our results showed that the natriuretic response to all diuretics was greater in MHS as compared to MNS when evaluated as absolute Na+ excretion (UNA+); this is likely because of the faster basal glomerular filtration rate (GFR) in the hypertensive strain (874 +/- 126 in MHS vs. 556 +/- 33 microliters.min-1.g-1 k wt in MNS, P less than 0.05). However, when calculated either as a difference from basal values (delta UNa+), or per ml of glomerular filtration rate, the response of MHS kidneys to amiloride and hydrochlorothiazide was similar in the two strains: delta UNa+ after amiloride at (10(-4) M was + 2.1 +/- 0.7 in MHS versus + 1.2 +/- 0.2 mumol.g-1.g-1 k wt in MNS; after hydrochlorothiazide 10(-4) M it was + 1.7 +/- 0.9 in MHS versus + 1.1 +/- 0.4 mumol.min-1.g-1 k wt in MNS, values not statistically different.(ABSTRACT TRUNCATED AT 250 WORDS)

Erythrocyte concentrations and transmembrane fluxes of sodium and potassium in essential hypertension: role of intrinsic and environmental factors

The intraerythrocyte sodium concentration is increased in the erythrocytes of Zaïrean Bantu with untreated hypertension, while the red blood cell potassium is not different from that of normotensive subjects. Compared with whites, normotensive healthy blacks have a higher intracellular concentration of sodium due to a depressed activity of the sodium-potassium pump. Normotensive healthy males with a positive familial background of hypertension display higher erythrocyte sodium and lower cotransport activity. None of the two measurements offer a clear-cut genetic marker of essential hypertension. In healthy women, the erythrocyte sodium concentration is lowered during the luteal as compared with the follicular phase of the menstrual cycle. This variability explains the difference observed between men and women. A low-sodium diet stimulates the activity of the sodium-potassium ATPase pump, which leads to a decrease in the erythrocyte sodium concentration. Both alterations reverse only slowly during sodium repletion. It is therefore suggested that an adequate matching for race, sex, stage of the menstrual cycle (in women), family history of hypertension, and the amount of sodium in the diet should be a prerequisite for valid conclusions when interpreting the erythrocyte concentration and fluxes of sodium.

Membrane transport of ions in hypertension

A variety of disturbances in transmembrane monovalent and divalent cation fluxes has been described in blood cells from hypertensive patients. Other membrane properties, such as fluidity and calcium binding, are also altered. It is now abundantly clear that some of the inconsistencies in this field are due to poor matching of patients and controls. However, even when careful matching is carried out, differences in membrane functions are still seen. It is suggested that these are due to a disturbance in the physicochemical properties of the cell membrane, related to changes in cell membrane phospholipid fluidity. This change could maintain peripheral resistance either by directly or indirectly increasing tone or by predisposing to resistance vessel hypertrophy. Recent evidence emphasizes the role of the latter rather than the former in experimental hypertension. It is postulated that overactivity of the phosphoinositide second messenger system as a result of alteration in all membrane properties predisposes genetically susceptible individuals to resistance-vessel hypertrophy and hypertension.

Effects of aldosterone on intralymphocytic sodium and potassium in patients with essential hypertension

In vitro binding of aldosterone to mineralocorticoid receptors on human mononuclear leukocytes (HML) and its effects on the intracellular sodium and potassium concentrations of HML have already been described. In the present paper this easily accessible human cell model was investigated in 13 patients with essential hypertension. In only four patients sodium in HML without incubation was elevated compared with the range for normal persons. A decrease of intracellular sodium or potassium occurred during incubation without aldosterone (P less than 0.02). The addition of 1.4 nM aldosterone did not prevent this loss of electrolytes as observed in normal persons. Plasma renin activity and aldosterone were not correlated with the electrolyte response and were within the normal limits. The number of mineralocorticoid receptors/cell were within or close to the normal range (n = 9). The independence of intracellular electrolytes from aldosterone despite a normal number of mineralocorticoid receptors may reflect an impairment of the mineralocorticoid effector mechanism in the HML of patients with essential hypertension.

Effect of age, weight, race and sex on blood pressure and erythrocyte sodium pump characteristics

In order to examine whether erythrocyte membrane handling of sodium is influenced by factors other than hypertension, measurements of red cell sodium transport were studied in one hundred normotensive volunteers. Erythrocyte sodium content was found to increase with increasing age, body weight and mean arterial pressure (MAP). It is also significantly correlated with age, body weight and MAP. Total sodium efflux was found to be reduced and negatively correlated with age and body weight. A reduction in ouabain-sensitive sodium efflux was also observed with increasing age and body weight. In males, the rate of ouabain-sensitive sodium efflux is higher than in females. Race was found to have no effect on erythrocyte electrolyte content and cationic flux rates of subjects. These data suggest that when studies in hypertension are going to be carried out, control subjects carefully matched for age, body weight and sex should be used if confounding results are not to be obtained.

Sodium-lithium exchange and sodium-proton exchange are mediated by the same transport system in sarcolemmal vesicles from bovine superior mesenteric artery

Several laboratories have reported that Na+-Li+ countertransport activities are increased in red blood cells from patients with essential hypertension. It has been proposed that the activity of this red blood cell transport system might reflect the activity of a similar system in vascular smooth muscle. We previously demonstrated Na+-Li+ exchange in sarcolemmal vesicles from canine artery and proposed that this transport function might be mediated by the Na+-H+ exchanger. In the present studies, however, we were unable to demonstrate Na+-Li+ countertransport in canine red blood cells. Since bovine red blood cells have a vigorous Na+-Li+ exchanger and we previously demonstrated Na+-H+ exchange in sarcolemmal vesicles from bovine artery, we wished to determine whether bovine sarcolemmal vesicles mediate Na+-Li+ exchange and whether this transport function is mediated via the Na+-H+ exchanger. We found that an outwardly directed proton or Li+ gradient stimulated 22Na+ uptake in sarcolemmal vesicles from bovine superior mesenteric artery. Li+ gradient-stimulated Na+ uptake was not due to electrical coupling between the two ions, was not affected by a change in membrane potential, and could not be explained by the parallel operation of Li+-H+ and Na+-H+ exchange. External Li+ inhibited proton gradient-stimulated Na+ uptake, and external protons inhibited Li+ gradient-stimulated Na+ uptake. Na+ efflux from vesicles was stimulated by inwardly directed gradients for Li+ or protons, and these effects were not additive. Proton efflux from vesicles was stimulated by inwardly directed gradients for Na+ or Li+, and these effects were not additive. Finally, Na+-H+ exchange and Na+-Li+ exchange in sarcolemmal vesicles were inhibited by 5-(N-ethyl-N-isopropyl)amiloride in an identical dose-dependent manner. In conclusion, Na+-Li+ countertransport could not be demonstrated in canine red blood cells, but as is the case with bovine red blood cells, sarcolemmal vesicles from bovine artery mediate Na+-Li+ countertransport. This transport function and sarcolemmal Na+-H+ exchange are mediated via a single 5-(N-ethyl-N-isopropyl)amiloride-sensitive cation exchanger with affinity for Na+, Li+, and protons. The cow, as opposed to the dog, may be a good animal model to test whether the activity of red blood cell Na+-Li+ countertransport is predictive of the activity of Na+-Li+ (and Na+-H+) exchange in vascular smooth muscle.

Clinical profiles and erythrocyte Na+ transport abnormalities of four major types of primary hypertension in Spain

The interaction of three different Na+ transport systems (Na+-K+ pump, Na+-K+ cotransport and Na+-Li+ countertransport), with internal Na+ and the passive Na+ leaks, were measured in erythrocytes from 72 Spanish, essential hypertensive patients and 30 normotensive controls. According to the observed abnormalities in Na+ transport pathways, 93.1% of the patients were classified into the following subsets: 12 (16.7%) exhibited a decreased apparent affinity of Na+-K+ pump for internal Na+ (Pump "-" hypertensives); 20 (27.7%) showed a decreased apparent affinity of Na+-K+ cotransport for internal Na+ (Co "-" hypertensives); 27 (37.5%) showed an accelerated Na+-Li+ countertransport (Counter "+" hypertensives); and 5 (6.9%) exhibited an increased rate constant of passive Na+ leaks (Leak "+" hypertensives). Finally, 5 patients (6.9%) did not show any abnormality in their Na+ transport systems and 3 exhibited more than one. Moreover, distinctive clinical features were recognize in Co "-" and Counter "+" subsets. Blood pressure values were lower in the former and, conversely, Counter "+" hypertensives showed a higher prevalence of moderate or severe hypertension (65.5% vs. 32.6%; P = 0.0059) and higher values of stimulated plasma renin activity (1.63 +/- 0.52 vs. 0.81 +/- 0.15; P = 0.0443). Our results confirm the heterogeneity of Na+ transport abnormalities in essential hypertension and suggest that these subsets of hypertensives could represent clinical entities.

Characterization of the calpastatin defect in erythrocytes from patients with essential hypertension

In erythrocytes of patients with essential hypertension the level of calpastatin activity was found to be significantly lower than in red cells of normotensive subjects (1). We now demonstrate, by Western blot analysis, that the decreased inhibitory activity is due to a corresponding decrease in the amount of the inhibitor protein. This is also supported by the observation that calpastatins isolated and purified from erythrocytes of normotensive and hypertensive patients, have identical specific activity. Data are presented indicating that the decreased level of calpastatin cannot be ascribed to an accelerated decay of the inhibitor during the erythrocyte life span. Taken together the previous and present results further emphasize that an umbalanced proteolytic system may represent one of the molecular mechanisms responsible for those membrane abnormalities underlying the development of essential hypertension and its clinical complications.

Erythrocyte deficiency in calpain inhibitor activity in essential hypertension

The calpain-calpain inhibitor system was evaluated in erythrocytes of patients with essential hypertension and normotensive controls, either with or without a family history of hypertension. Calpain levels were similar in the controls and hypertensive patients, whereas the inhibitor activity level was significantly reduced in the latter (301.8 +/- 26.4 vs 220 +/- 14 U/mg hemoglobin, p less than 0.001). Borderline hypertensive patients and a few controls with a history of hypertension showed low inhibitor activity. Similar results have recently been reported in genetically hypertensive rats of the Milan strain. A significant inverse correlation (r = -0.43, p less than 0.001) was found between mean arterial pressure and calpain inhibitor. Although the pathophysiological significance of these observations is not yet clear, they suggest a new area of investigation into the molecular mechanisms underlying essential hypertension and its complications.

Use of 86Rb and 22Na in assaying active and cotransport activities in human erythrocytes in a biracial population

A defect in Na+-K+ transport across the red cell membrane has been shown to be associated with essential hypertension. A sensitive assay system to measure active, co- and countertransport systems in erythrocytes from normotensive adults was developed. Active, co- and countertransport systems in the erythrocytes were assayed by measuring the influx of radioactive 22Na+ and 86Rb+. In the biracial (black-white) population group studied, analysis of variance of the active transport showed a significant race effect (p = 0.003). Cotransport activity showed age by race interaction (p = 0.001) and age by sex (p = 0.02). Cotransport activity was significantly higher in whites than blacks (p = 0.0001). Countertransport activity did not vary either by sex or race. Of the Spearman correlation coefficients for transport activities and blood pressure, white males showed a strong positive correlation with countertransport, whereas in black males, blood pressures showed a strong interaction with active transport. Among the transport activities, active transport showed significant interaction with countertransport activity in black males, whereas cotransport activity in whites showed a strong interaction with countertransport. The results suggest a subtle difference in Na+-K+ transport systems between blacks and whites, and these variations may be related to differences for susceptibility to essential hypertension.

Abnormal Na+-K+ ATPase kinetics in a subset of essential hypertensive patients

We have performed a kinetic analysis of the interaction of Na+-K+ ATPase with internal Na+ in erythrocytes of 30 normotensive controls and 72 essential hypertensive patients. Neither the maximal rate of ouabain-sensitive sodium efflux (Vmax) nor the internal Na+ content required for half-maximal stimulation (K50%) were significantly different between normotensive and hypertensive patients. Nevertheless, using the 95% confidence limits of the K50% in the normotensive group as a cut-off point, 13 (18.06%) essential hypertensive patients exhibited increased values of this parameter (29.16 +/- 4.31 mmol l-1 cells) revealing decreased affinity of Na+-K+ ATPase for internal Na+ (Pump-hypertensives). The Vmax was also higher in the Pump '-' subset (14.08 +/- 4.85 mmol (1 cells h)-1 vs. 6.92 +/- 1.80; P = 0.0002) and 10 of these 13 hypertensives exhibited a Vmax above the upper end limit of 10.5 mmol (1 cells h)-1, suggesting a compensatory effect. No differences were observed between the Pump '-' subset and the remaining 59 hypertensives without Na+-K+ pump abnormality when basal erythrocyte Na+ content and clinical parameters of hypertension were examined. Decreased apparent affinity of Na+-K+ pump for internal Na+ present in 9-27% of essential hypertensives may be implicated in pathogenetic mechanisms of hypertension.

Reduced Na-K-Cl cotransport in vascular smooth muscle cells from spontaneously hypertensive rats

We have previously demonstrated the presence of a prominent, cyclic nucleotide-sensitive Na-K-Cl cotransport in vascular smooth muscle cells (VSMC). Others have observed that Na-K-Cl cotransport levels are reduced in erythrocytes of patients with essential hypertension and have proposed that a defect in this Na transport system may play a role in the pathogenesis of the disease. However, such a defect has not been demonstrated in the putative target tissue for essential hypertension, i.e., the VSMC. In the present study, we compared Na-K-Cl cotransport of VSMC from spontaneously hypertensive rats (SHR) with Na-K-Cl cotransport of VSMC from normotensive Wistar-Kyoto rats (WKY). We found that Na-K-Cl cotransport of SHR VSMC is significantly reduced relative to that of WKY VSMC (3.09 vs. 4.39 mumol K.g protein-1.min-1). The apparent ion affinities for Na-K-Cl cotransport of SHR VSMC did not differ from those determined for WKY VSMC. Furthermore, cyclic nucleotide regulation of cotransport also appeared to be the same for the two types of VSMC. In contrast, maximal saturable binding of [3H]bumetanide observed in SHR VSMC was markedly reduced compared with that of WKY VSMC, but the Kd values were similar. Our data suggest that the reduction in cotransport observed in SHR VSMC is the result of a decrease in the number of available cotransport sites.

(Na+ -K+)ATPase activity in erythrocyte membranes of spontaneously, one kidney-one wrapped, and deoxycorticosterone acetate--NaCl hypertensive rats

(Na+ -K+)ATPase activity in erythrocyte membranes of spontaneously (SHR), one kidney-one wrapped, and deoxycorticosterone acetate (DOCA)-NaCl hypertensive rats was studied. (Na+ -K+) ATPase activity decreased in both prehypertensive (6 weeks old) and hypertensive (14 weeks old) stages of SHR, suggesting that the alteration of this enzymic activity may be due to a pre-existing defect in the membrane rather than being a consequence of hypertension. By contrast, (Na+ -K+)ATPase activity remained unchanged in the one kidney-one wrapped hypertensive rats, whereas that of one kidney-one wrapped normotensive rats as well as that of DOCA-NaCl hypertensive rats was increased significantly (P less than 0.05). These changes were specific for (Na+ -K+) ATPase, since Mg2+-ATPase activity was not altered. The susceptibility of (Na+ -K+)ATPase to the inhibitory action of ouabain was not changed significantly. These findings indicate that (Na+ -K+)ATPase activities of erythrocyte membranes isolated from the different types of hypertensive rats were subject to different changes. Whether this phenomenon applies to the clinical distinctions among the various types of hypertension remains a subject for further investigation.

A role of calcium in altered sodium ion transport of hypertensives?

Research on the etiology of essential hypertension has led to many reports of altered ion transport in cells from hypertensive patients and animal models. Abnormalities in sodium and calcium ion gradients and transport in vascular smooth muscle, neuronal tissue, cardiac muscle as well as erythrocytes have been extensively investigated. It is not clear whether these abnormalities are of primary or secondary nature. The current knowledge of sodium and calcium ion transport in essential hypertension is briefly reviewed here. Furthermore, evidence is presented which suggests a role of calcium in the regulation of sodium transport activity.

In vitro action of insulin on erythrocyte sodium transport mechanisms: its possible role in the pathogenesis of arterial hypertension

The effects of insulin on sodium and potassium metabolism have been well known for many years; clinical observation and laboratory experience showed different results about the insulin effect on the sodium-potassium pump. Moreover, studies about the insulin effect on the sodium-potassium cotransport are not available. Therefore, the effects of insulin on Na+,K+ pump and Na+,K+ cotransport were evaluated. Results show that insulin inhibits Na+,K+ pump, while Na+,K+ cotransport is markedly activated. The possible link between pathogenesis of arterial hypertension in hyperinsulinemic subjects and present data is examined.

Kinetic aspects of red blood cell sodium transport systems in essential hypertension

A kinetic study of the interaction of internal sodium with four different erythrocyte sodium transport pathways (ouabain-sensitive Na+-K+ pump, bumetanide-sensitive Na+-K+ cotransport system, Na+-Li+ countertransport, and Na+leak) has facilitated the distinction of the following subgroups of patients with essential hypertension: 1) Leak (+), exhibiting increased passive sodium permeability; 2) Co (-), showing low apparent affinity of the Na+-K+ cotransport system for internal sodium; 3) Counter (+), characterized by increased maximal rates of Na+-Li+ countertransport; and 4) Pump (-), characterized by an abnormally low apparent affinity of the Na+-K+ pump for internal sodium. We present here a new and simple sodium-loading method that allows a simultaneous kinetic study of the above abnormalities. The use of this kinetic assay may improve estimation of the frequencies, clinical features, and other properties of each subgroup of hypertensive patients in different populations.

Genetic studies of cation tests and hypertension

Several tests of cation concentration and transport are being studied among members of large Utah pedigrees as part of a study of the genetic and environmental determinants of essential hypertension. Corrected urinary sodium excretion and plasma sodium concentration correlated well in spouses and siblings (r = 0.21-0.54, p less than 0.001), suggesting the effects of shared family environment (e.g., sodium intake). Intraerythrocytic sodium concentration and sodium-lithium countertransport showed no significant correlation in spouses and very significant correlations between siblings and between parents and offspring (r = 0.34-0.58, p less than 0.001), suggesting mostly genetic determination. Using maximum likelihood tests of different genetic models, both sodium-lithium countertransport and intraerythrocytic sodium showed predominantly polygenic determination (H2 = 70%) and some possible major gene determinants (H2 = 18-25%) for a total heritability of 89 to 95% for these characteristics. These data suggest both genes and shared family environment contribute to the familiality of cation tests. They also illustrate the need and utility of quantitative methods for objective analysis of pedigree data.