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Zhang Z, Liao H, Zhang X, Meng Q, Shi R, Feng J, Li X, Gou Q, Ye R, Hu X, Chen X. Associations of urinary sodium excretion with central hemodynamics and changes in vascular structure and function at high altitude. J Clin Hypertens (Greenwich) 2021; 23:1907-1914. [PMID: 34477293 PMCID: PMC8678796 DOI: 10.1111/jch.14356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023]
Abstract
Research reports on associations of urinary sodium excretion with central hemodynamic parameters and vascular changes are quite limited in general or non‐hypertensive population. The purpose of the current study was to explore such associations in Chinese general Tibetans living at high altitude. This cross‐sectional study was conducted in Luhuo County, Ganzi Tibetan Autonomous Prefecture with average elevation of 3800 meters from December 2018 to January 2019. A total of 294 Tibetans were included in the current study. Twenty‐four hour urinary sodium excretion was estimated by second fasting spot urine in the morning using Kawasaki formula. Central hemodynamic parameters, including central systolic blood pressure (CSBP), central diastolic blood pressure (CDBP), central pulse pressure (CPP), central mean arterial pressure (CMAP), augmentation pressure (AP), and augmentation index standardized for heart rate of 75 (AIx75), were evaluated using the SphygmoCor system. Vascular structures and functions were assessed by carotid intima media thickness (CIMT) test and brachial ankle pulse wave velocity (baPWV), respectively. Estimated mean 24h urinary sodium excretion of Tibetans in Luhuo County was 5.26±1.61 g. After adjustment, estimated 24h urinary sodium was positively associated with CSBP (β = 1.15, p = .008) and CPP (β = 0.87, p = .013). Line graph of means across urinary sodium quartiles showed that associations of 24 h urinary sodium excretion with AIx75 and baPWV presented approximate “J” shape after controlling for confounders. Estimated 24 h sodium excretion was independently and positively associated with CSBP and CPP. Moreover, association between urinary sodium excretion and arterial elasticity, as evaluated by baPWV and AIx75, presented “J” shape. Further studies are needed to verify J‐shaped association and “safe” zone of sodium intake.
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Affiliation(s)
- Zhipeng Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qingtao Meng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Rufeng Shi
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayue Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinran Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiling Gou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Runyu Ye
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xianjin Hu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Tagawa K, Tsuru Y, Yokoi K, Aonuma T, Hashimoto J. Albuminuria Intensifies the Link Between Urinary Sodium Excretion and Central Pulse Pressure in the General Population: The Wakuya Study. Am J Hypertens 2021; 34:851-857. [PMID: 33893813 PMCID: PMC8385571 DOI: 10.1093/ajh/hpab057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/23/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Central pulse pressure (cPP) is responsible for the hemodynamics of vital organs, and monitoring this parameter is important for cardiovascular disease (CVD) prevention. Excess sodium intake and (micro)albuminuria (a manifestation of renal microvascular damage) are known to be strong predictors of CVD. We sought to investigate the cross-sectional relationships among dietary sodium intake, albuminuria, and cPP in a general population cohort. METHODS The subjects were 933 apparently healthy adults (mean age, 56 ± 10 years). Radial pressure waveforms were recorded with applanation tonometry to estimate mean arterial pressure (MAP), cPP, forward and backward pressure amplitudes, and augmentation index. The urinary sodium/creatinine and albumin/creatinine ratios were measured in spot urine samples. RESULTS Both the urinary sodium/creatinine and albumin/creatinine ratios were positively correlated with cPP, even after adjusting for MAP (P < 0.001). Moreover, both ratios had a synergistic influence on increasing the cPP independent of age, sex, estimated glomerular filtration rate, hyperlipidemia, and diabetes (interaction P = 0.04). A similar synergistic influence was found on the forward pressure amplitude, but not on the backward pressure amplitude or augmentation index. The overall results were not altered when the urinary albumin/creatinine ratio was replaced with the existence of chronic kidney disease (CKD). CONCLUSIONS (Micro)albuminuria strengthens the positive association between urinary sodium excretion and cPP and systolic forward pressure. Excess sodium intake may magnify the cardiovascular risk by widening the aortic pulsatile pressure, particularly in the presence of concomitant CKD.
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Affiliation(s)
- Kaname Tagawa
- Miyagi University of Education Medical Center, Sendai, Japan
| | - Yusuke Tsuru
- Wakuya National Health Insurance Hospital, Miyagi, Japan
| | - Katsumi Yokoi
- Wakuya National Health Insurance Hospital, Miyagi, Japan
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Zhou J, Wang D, Li B, Li X, Lai X, Lei S, Li N, Zhang X. Relationship between Plasma Trimethylamine N-Oxide Levels and Renal Dysfunction in Patients with Hypertension. Kidney Blood Press Res 2021; 46:421-432. [PMID: 34233325 DOI: 10.1159/000513033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Trimethylamine N-oxide (TMAO) is a metabolite produced by gut bacteria. Although increased TMAO levels have been linked to hypertension (HTN) and chronic kidney disease (CKD) with poor prognosis, no clinical studies have directly addressed the relationship between them. In this study, we investigated the relationship between TMAO and renal dysfunction in hypertensive patients. METHODS We included healthy controls (n = 50), hypertensive patients (n = 46), and hypertensive patients with renal dysfunction (n = 143). Their blood pressure values were taken as the highest measured blood pressure. Renal function was evaluated using the estimated glomerular filtration rate. Plasma TMAO levels were measured using high-performance liquid chromatography tandem mass spectrometry. RESULTS We found significant differences in plasma TMAO levels among the 3 groups (p < 0.01). The plasma TMAO of patients with HTN was significantly higher than that of healthy people, and the plasma TMAO of patients with HTN complicated by renal dysfunction was significantly higher than either of the other groups. Patients in the highest TMAO quartile were at a higher risk of developing CKD stage 5 than those in the lowest quartile. In the receiver operating characteristic curve, the area under the curve of TMAO combined with β 2-macroglobulin for predicting renal dysfunction in patients with HTN was 0.85 (95% confidence interval 0.80-0.90). CONCLUSION An elevated TMAO level reflects higher levels of HTN and more severe renal dysfunction. TMAO, combined with β 2-macroglobulin levels, may assist in diagnosing CKD in hypertensive patients. Plasma TMAO has predictive value for early kidney disease in hypertensive patients.
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Affiliation(s)
- Jia Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dingkun Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bingong Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Cardiovascular Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Xuelian Li
- Department of Cardiovascular Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Xingjun Lai
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shufang Lei
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Na Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xuting Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Cunha MR, Cunha AR, Marques BCAA, Mattos SS, D’El-Rei J, França NM, Oigman W, Neves MF. Association of urinary sodium/potassium ratio with structural and functional vascular changes in non‐diabetic hypertensive patients. J Clin Hypertens (Greenwich) 2019; 21:1360-1369. [DOI: 10.1111/jch.13660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Michelle R. Cunha
- Department of Clinical Medicine State University of Rio de Janeiro Rio de Janeiro RJ Brazil
| | - Ana R. Cunha
- Department of Clinical Medicine State University of Rio de Janeiro Rio de Janeiro RJ Brazil
| | | | - Samanta S. Mattos
- Department of Clinical Medicine State University of Rio de Janeiro Rio de Janeiro RJ Brazil
| | - Jenifer D’El-Rei
- Department of Clinical Medicine State University of Rio de Janeiro Rio de Janeiro RJ Brazil
| | - Natalia M. França
- Department of Clinical Medicine State University of Rio de Janeiro Rio de Janeiro RJ Brazil
| | - Wille Oigman
- Department of Clinical Medicine State University of Rio de Janeiro Rio de Janeiro RJ Brazil
| | - Mario F. Neves
- Department of Clinical Medicine State University of Rio de Janeiro Rio de Janeiro RJ Brazil
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Lee HY, Shin J, Kim GH, Park S, Ihm SH, Kim HC, Kim KI, Kim JH, Lee JH, Park JM, Pyun WB, Chae SC. 2018 Korean Society of Hypertension Guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension. Clin Hypertens 2019; 25:20. [PMID: 31388453 PMCID: PMC6670135 DOI: 10.1186/s40885-019-0124-x] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023] Open
Abstract
The standardized techniques of blood pressure (BP) measurement in the clinic are emphasized and it is recommended to replace the mercury sphygmomanometer by a non-mercury sphygmomanometer. Out-of-office BP measurement using home BP monitoring (HBPM) or ambulatory BP monitoring (ABPM) and even automated office BP (AOBP) are recommended to correctly measure the patient’s genuine BP. Hypertension (HTN) treatment should be individualized based on cardiovascular (CV) risk and the level of BP. Based on the recent clinical study data proving benefits of intensive BP lowering in the high risk patients, the revised guideline recommends the more intensive BP lowering in high risk patients including the elderly population. Lifestyle modifications, mostly low salt diet and weight reduction, are strongly recommended in the population with elevated BP and prehypertension and all hypertensive patients. In patients with BP higher than 160/100 mmHg or more than 20/10 mmHg above the target BP, two drugs can be prescribed in combination to maximize the antihypertensive effect and to achieve rapid BP control. Especially, single pill combination drugs have multiple benefits, including maximizing reduction of BP, minimizing adverse effects, increasing adherence, and preventing cardiovascular disease (CVD) and target organ damage.
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Affiliation(s)
- Hae-Young Lee
- 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jinho Shin
- 2Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Gheun-Ho Kim
- 2Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sungha Park
- 3Department of Internal Medicine, Yonsei University, Seoul, Korea
| | - Sang-Hyun Ihm
- 4Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Chang Kim
- 3Department of Internal Medicine, Yonsei University, Seoul, Korea
| | - Kwang-Il Kim
- 5Department of Internal Medicine, Seoul National University, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ju Han Kim
- Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, Korea
| | - Jang Hoon Lee
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong-Moo Park
- 8Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Wook Bum Pyun
- 9Cardiovascular Center, Seoul Hospital, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Shung Chull Chae
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Siriopol D, Covic A, Iliescu R, Kanbay M, Tautu O, Radulescu L, Mitu O, Salaru D, Dorobantu M. Arterial stiffness mediates the effect of salt intake on systolic blood pressure. J Clin Hypertens (Greenwich) 2018; 20:1587-1594. [DOI: 10.1111/jch.13399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Dimitrie Siriopol
- Nephrology Department; “Grigore T. Popa” University of Medicine and Pharmacy; Iasi Romania
| | - Adrian Covic
- Nephrology Department; “Grigore T. Popa” University of Medicine and Pharmacy; Iasi Romania
| | - Radu Iliescu
- Pharmacology Department; “Grigore T. Popa” University of Medicine and Pharmacy; Iasi Romania
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine; Koc University School of Medicine; Istanbul Turkey
| | - Oana Tautu
- Cardiology Department; “Carol Davila” University of Medicine and Pharmacy; Bucharest Romania
| | - Luminita Radulescu
- Nephrology Department; “Carol Davila” University of Medicine and Pharmacy; Bucharest Romania
| | - Ovidiu Mitu
- Cardiology Department; “Grigore T. Popa” University of Medicine and Pharmacy; Iasi Romania
| | - Delia Salaru
- Cardiology Department; “Grigore T. Popa” University of Medicine and Pharmacy; Iasi Romania
| | - Maria Dorobantu
- Cardiology Department; “Carol Davila” University of Medicine and Pharmacy; Bucharest Romania
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Saladini F, Palatini P. Arterial Distensibility, Physical Activity, and the Metabolic Syndrome. Curr Hypertens Rep 2018; 20:39. [DOI: 10.1007/s11906-018-0837-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Xing X, Liu F, Yang X, Huang C, Zhang D, Chen S, Chen J, Li J, Liu Z, Lu F, Gu D, Huang J. Central Blood Pressure Responses to Dietary Sodium and Potassium Interventions. Am J Hypertens 2018; 31:582-589. [PMID: 29385399 DOI: 10.1093/ajh/hpx209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 01/16/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To explore how central hemodynamics respond to dietary sodium and potassium interventions, and whether the responses are associated with metabolic traits. METHODS We conducted a dietary intervention study including a 7-day low-sodium (51.3 mmol sodium/day) intervention, a 7-day high-sodium (307.8 mmol sodium/day) intervention, and a 7-day high-sodium with potassium supplementation (60.0 mmol potassium/day) intervention among 99 northern Chinese subjects aged 18-60 years. Five metabolic traits included abdominal obesity, high triglycerides, low HDL cholesterol, raised blood pressure (BP), and high glucose. Central hemodynamics were measured at baseline and during each intervention. RESULTS Central systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and augmentation index (AIx@75) significantly decreased during low-sodium intervention, increased during high-sodium intervention, and then decreased during potassium supplementation. We observed potential linear trends toward significance of central SBP and PP responses to low-sodium intervention, and significant linear trends of responses to high-sodium intervention as the number of metabolic traits grows. For example, among participants with 0 or 1, 2 or 3, and 4 or 5 metabolic traits, central SBP responses to high-sodium intervention were 8.8 [95% confidence interval (5.8, 11.8)], 9.3 (7.1, 11.6), and 14.0 (11.6, 16.3) mmHg, respectively (P for trend = 0.009). Significant linear trends of central SBP and DBP responses to potassium supplementation were also observed. CONCLUSIONS Central BP and AIx@75 were lowered by sodium reduction and potassium supplementation, and elevated by sodium-loading. The responses of central BP were pronounced among individuals with metabolic traits clustering. CLINICAL TRIALS REGISTRATION Trial Number NCT00721721 (The current study is registered on ClinicalTrials.gov; https://clinicaltrials.gov).
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Affiliation(s)
- Xiaolong Xing
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Fangchao Liu
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Xueli Yang
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Chen Huang
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Dingding Zhang
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Shufeng Chen
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jichun Chen
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jianxin Li
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Zhendong Liu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, China
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, China
| | - Dongfeng Gu
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jianfeng Huang
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
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10
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Afsar B, Sag AA, Kanbay M. Should we take renal denervation with a grain of salt? J Clin Hypertens (Greenwich) 2017; 19:1134-1136. [PMID: 28942601 DOI: 10.1111/jch.13069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Baris Afsar
- Division of Nephrology, Department of Medicine, Suleyman Demirel University School of Medicine, Faculty of Medicine, Isparta, Turkey
| | - Alan A Sag
- Division of Interventional Radiology, Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
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11
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Relationships between urinary electrolytes excretion and central hemodynamics, and arterial stiffness in hypertensive patients. Hypertens Res 2017; 40:746-751. [DOI: 10.1038/hr.2017.29] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/18/2017] [Accepted: 01/21/2017] [Indexed: 12/19/2022]
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12
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Relationship between 24-h urine sodium/potassium ratio and central aortic systolic blood pressure in hypertensive patients. Hypertens Res 2016; 40:405-410. [DOI: 10.1038/hr.2016.161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/05/2016] [Accepted: 10/09/2016] [Indexed: 12/15/2022]
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Koma MP, Lebelo SL. Prevalence of Hypertension and Associated Risk Factors among Rural Bapedi Women in Sekhukhune Area, Limpopo Province, South Africa. Ecol Food Nutr 2016; 56:31-44. [PMID: 27841668 DOI: 10.1080/03670244.2016.1247702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The study investigated the prevalence of hypertension and identified risk factors in the Bapedi women of Sekhukhune area. Fifty (50) women diagnosed with hypertension and receiving treatment from local clinics were recruited. Questionnaires and focus group discussions were used. Most participants were at the average age of 50.50 ± 7.93 years and weight of 81.17 ± 9.96 kg. Blood pressure measurements recorded were systolic blood pressure (SBP) 163 ± 22.41 mmHg and diastolic blood pressure (DBP) 91 ± 5.41 mmHg. An insignificant number of participants had smoking or drinking habits (0% and 2%, respectively). The largest group of women (46%) had primary level of education, 14% completed junior secondary education, 6% completed matric, and 2% had basic education. All women consumed cereal; a large number of women (50%) consumed oils and fats; 44% flesh meats; 30% fruits and vegetables; 26% tubers and roots; 22% organ meats; 10% fish, 10% eggs, and 8% milk. Results showed a high prevalence of hypertension in the Bapedi women in the Sekhukhune area. Changes in diet and lifestyle could significantly improve the health of most women in the area.
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Affiliation(s)
- Mabaile Pauline Koma
- a Department of Agriculture and Animal Health , College of Agriculture and Environmental Sciences, University of South Africa , Pretoria , South Africa
| | - Sogolo Lucky Lebelo
- b Department of Life and Consumer Sciences , College of Agriculture and Environmental Sciences, University of South Africa , Pretoria , South Africa
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Rhee MY, Kim JH, Shin SJ, Gu N, Nah DY, Park JH, Kim SW, Kim HJ, Oh KW, Kim JH, Lee SY. Estimating 24-Hour Urine Sodium From Multiple Spot Urine Samples. J Clin Hypertens (Greenwich) 2016; 19:431-438. [DOI: 10.1111/jch.12922] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/21/2016] [Accepted: 08/23/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
- Clinical Trial Center; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
| | - Ji-Hyun Kim
- Cardiovascular Center; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
| | - Sung-Joon Shin
- Division of Nephrology; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
| | - Namyi Gu
- Clinical Trial Center; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
- Department of Clinical Pharmacology and Therapeutics; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
| | - Deuk-Young Nah
- Cardiovascular Center; Dongguk University Gyeongju Hospital; Gyeongju-si Gyeongsangbuk-do Korea
| | - Ju-Hyun Park
- Department of Statistics; Dongguk University; Jung-gu Seoul Korea
| | - Sun-Woong Kim
- Department of Statistics; Survey and Health Policy Research Center; Dongguk University; Jung-gu Seoul Korea
| | - Hyun Ja. Kim
- Department of Food and Nutrition; Gangneung-Wonju National University; Gangneung-si Gangwon-do Korea
| | - Kyung Won. Oh
- Division of Health and Nutrition Survey; Korea Centers for Disease Control and Prevention; Heungdeok-gu Cheongju-si Korea
| | - Ji-Hyeon Kim
- Department of Pediatrics; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
| | - Sim-Yeol Lee
- Department of Home Economics Education; Dongguk University; Jung-gu Seoul Korea
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Baldo MP, Rodrigues SL, Mill JG. High salt intake as a multifaceted cardiovascular disease: new support from cellular and molecular evidence. Heart Fail Rev 2016; 20:461-74. [PMID: 25725616 DOI: 10.1007/s10741-015-9478-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Scientists worldwide have disseminated the idea that increased dietary salt increases blood pressure. Currently, salt intake in the general population is ten times higher than that consumed in the past and at least two times higher than the current recommendation. Indeed, a salt-rich diet increases cardiovascular morbidity and mortality. For a long time, however, the deleterious effects associated with high salt consumption were only related to the effect of salt on blood pressure. Currently, several other effects have been reported. In some cases, the deleterious effects of high salt consumption are independently associated with other common risk factors. In this article, we gather data on the effects of increased salt intake on the cardiovascular system, from infancy to adulthood, to describe the route by which increased salt intake leads to cardiovascular diseases. We have reviewed the cellular and molecular mechanisms through which a high intake of salt acts on the cardiovascular system to lead to the progressive failure of a healthy heart.
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Affiliation(s)
- Marcelo Perim Baldo
- Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, Vitória, ES, 29042-755, Brazil,
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Arcand J, Wong MMY, Trieu K, Leung AA, Campbell NRC, Webster J, Johnson C, Raj TS, McLean R, Neal B. The Science of Salt: A Regularly Updated Systematic Review of Salt and Health Outcomes (June and July 2015). J Clin Hypertens (Greenwich) 2015; 18:371-7. [DOI: 10.1111/jch.12762] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- JoAnne Arcand
- Faculty of Health Sciences; University of Ontario Institute of Technology; Oshawa ON Canada
| | | | - Kathy Trieu
- The George Institute for Global Health; University of Sydney; Sydney NSW Australia
| | | | - Norm R. C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences; O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta; University of Calgary; Calgary AB Canada
| | - Jacqui Webster
- The George Institute for Global Health; University of Sydney; Sydney NSW Australia
| | - Claire Johnson
- The George Institute for Global Health; University of Sydney; Sydney NSW Australia
| | | | - Rachael McLean
- Departments of Preventive & Social Medicine/Human Nutrition; University of Otago; Dunedin New Zealand
| | - Bruce Neal
- The George Institute for Global Health; University of Sydney and the Royal Prince Alfred Hospital; Sydney NSW Australia
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Afsar B, Elsurer R. Central hemodynamics, vascular stiffness, and nocturia in patients with type 2 diabetes. Ren Fail 2015; 37:359-65. [PMID: 26381594 DOI: 10.3109/0886022x.2015.1088335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recently, studies have shown that the presence of nocturia may not be a benign condition and related with systemic illness and mortality. Elevated blood pressure (BP) was another factor related with nocturia. Type 2 diabetes mellitus (T2DM) is also associated with nocturia. It is now clear that, apart from peripheral BP, central hemodynamic parameters are important for cardiovascular prognosis. However, no previous study in the literature examined the relationship between nocturia and central hemodynamic parameters in patients with T2DM. The current study was designed to examine these relationships. Nocturia was defined as two or more voids per night. Central hemodynamic parameters were assessed from ambulatory BP measurements. In addition to routine biochemistry, 24-h urine collection was performed to measure protein, albumin, and sodium excretion. 158 patients (52.3%) had T2DM and 144 (47.7%) did not have T2DM (control group). The presence of T2DM was independently related with nocturia. Both in whole group and in T2DM patients, most of the hemodynamic parameters are higher in patients with nocturia compared to patients without nocturia. Among patients with T2DM, nocturia was associated with augmentation index and pulse wave velocity. In conclusion, central hemodynamic parameters and markers of vascular stiffness may be related with nocturia in patients with T2DM.
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Affiliation(s)
- Baris Afsar
- a Department of Nephrology , Konya Numune State Hospital , Konya , Turkey and
| | - Rengin Elsurer
- b Department of Nephrology , Selcuklu Faculty of Medicine, Selcuk University , Konya , Turkey
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Lee SK, Kim JS, Kim SH, Kim YH, Lim HE, Kim EJ, Park CG, Cho GY, Kim J, Baik I, Park J, Lee JB, Shin C. Sodium Excretion and Cardiovascular Structure and Function in the Nonhypertensive Population: The Korean Genome and Epidemiology Study. Am J Hypertens 2015; 28:1010-6. [PMID: 25534867 DOI: 10.1093/ajh/hpu254] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/24/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The effect of sodium intake on the cardiovascular system remains controversial. The purpose of this study is to investigate the relation between sodium intake and cardiovascular structure and function in the nonhypertensive population. METHODS We performed a cross-sectional analysis in 1,586 nonhypertensive subjects who participated in the Korean Genome Epidemiology Study (2007-2008). Sodium intake was assessed by estimating the 24-hour urinary sodium excretion from a spot urine sample. Changes in cardiovascular structure and function were assessed by using tissue Doppler echocardiography, the carotid intima-media thickness (CIMT), and the brachial-ankle pulse wave velocity (baPWV). RESULTS Systolic and diastolic blood pressures increased with increasing tertiles of estimated 24-hour urinary sodium excretion. In multivariate analyses adjusting for covariates, there were stepwise decreases in the baPWV (P = 0.003) and CIMT (P = 0.001) values as the estimated 24-hour urinary sodium excretion increased, whereas no significant differences in left ventricular (LV) structural and functional parameters were observed across the tertiles of estimated 24-hour urinary sodium excretion. Multiple linear regression analyses revealed that the estimated 24-hour urinary sodium excretion was independently and inversely associated with baPWV (P < 0.001) and CIMT (P = 0.001), but not with LV parameters. CONCLUSIONS In the nonhypertensive population, urinary sodium excretion was inversely related to baPWV and CIMT. However, there were no associations between urinary sodium excretion and LV structure or function.
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Affiliation(s)
- Seung Ku Lee
- Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan, Korea
| | - Jin-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Seong Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea;
| | - Yong Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Hong Euy Lim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Chang Gyu Park
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jinyoung Kim
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Inkyung Baik
- Department of Foods and Nutrition, College of Natural Sciences, Kookmin University, Seoul, Korea
| | - Juri Park
- Division of Endocrinology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jung Bok Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Chol Shin
- Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan, Korea
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19
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Rhee MY. High sodium intake: review of recent issues on its association with cardiovascular events and measurement methods. Korean Circ J 2015; 45:175-83. [PMID: 26023304 PMCID: PMC4446810 DOI: 10.4070/kcj.2015.45.3.175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 11/11/2022] Open
Abstract
There has been a long-known association between high dietary sodium intake and hypertension, as well as the increased risk of cardiovascular disease. Reduction of sodium intake is a major challenge for public health. Recently, there have been several controversial large population-based studies regarding the current recommendation for dietary sodium intake. Although these studies were performed in a large population, they aroused controversies because they had a flaw in the study design and methods. In addition, knowledge of the advantages and disadvantages of the methods is essential in order to obtain an accurate estimation of sodium intake. I have reviewed the current literatures on the association between sodium intake and cardiovascular events, as well as the methods for the estimation of sodium intake.
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Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center, Clinical Trial Center, Dongguk University Ilsan Hospital, Goyang, Korea
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20
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Shin J, Park JB, Kim KI, Kim JH, Yang DH, Pyun WB, Kim YG, Kim GH, Chae SC. 2013 Korean Society of Hypertension guidelines for the management of hypertension. Part II-treatments of hypertension. Clin Hypertens 2015; 21:2. [PMID: 26893916 PMCID: PMC4745141 DOI: 10.1186/s40885-014-0013-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/23/2014] [Indexed: 02/07/2023] Open
Abstract
Treatment strategies are provided in accordance with the level of global cardiovascular risk, from lifestyle modification in the lower risk group to more comprehensive treatment in the higher risk group. Considering the common trend of combination drug regimen, the choice of the first drug is suggested more liberally according to the physician's discretion.
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Affiliation(s)
- Jinho Shin
- />Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Bae Park
- />Division of Cardiology, Department of Medicine, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Kwang-il Kim
- />Department of Internal Medicine, School of Medicine, Seoul National University, Bundang, Korea
| | - Ju Han Kim
- />Department of Internal Medicine, School of Medicine, Chonnam University, Gwangju, Korea
| | - Dong Heon Yang
- />Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, 700-721 Jung-gu Daegu, Korea
| | - Wook Bum Pyun
- />Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Gweon Kim
- />Division of Cardiology, Department of Internal Medicine, Dongkuk University School of Medicine, Seoul, Korea
| | - Gheun-Ho Kim
- />Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Shung Chull Chae
- />Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, 700-721 Jung-gu Daegu, Korea
| | - The Guideline Committee of the Korean Society of Hypertension
- />Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- />Division of Cardiology, Department of Medicine, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
- />Department of Internal Medicine, School of Medicine, Seoul National University, Bundang, Korea
- />Department of Internal Medicine, School of Medicine, Chonnam University, Gwangju, Korea
- />Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, 700-721 Jung-gu Daegu, Korea
- />Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
- />Division of Cardiology, Department of Internal Medicine, Dongkuk University School of Medicine, Seoul, Korea
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21
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Park JB, Kario K, Wang JG. Systolic hypertension: an increasing clinical challenge in Asia. Hypertens Res 2015; 38:227-36. [PMID: 25503845 PMCID: PMC4396396 DOI: 10.1038/hr.2014.169] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/14/2014] [Accepted: 10/26/2014] [Indexed: 12/21/2022]
Abstract
Systolic hypertension, the predominant form of hypertension in patients aged over 50-60 years, is a growing health issue as the Asian population ages. Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects. Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs. Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications.
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Affiliation(s)
- Jeong Bae Park
- Department of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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22
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Afsar B, Elsurer R, Kirkpantur A, Kanbay M. Urinary Sodium Excretion and Ambulatory Blood Pressure Findings in Patients With Hypertension. J Clin Hypertens (Greenwich) 2015; 17:200-6. [DOI: 10.1111/jch.12464] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/05/2014] [Accepted: 11/09/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Baris Afsar
- Department of Nephrology; Konya Numune State Hospital; Konya Turkey
| | - Rengin Elsurer
- Department of Nephrology; Selcuklu Faculty of Medicine; Selcuk University; Konya Turkey
| | | | - Mehmet Kanbay
- Division of Nephrology; Department of Medicine; Koc University School of Medicine; Istanbul Turkey
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23
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Izzo JL. Brachial vs. central systolic pressure and pulse wave transmission indicators: a critical analysis. Am J Hypertens 2014; 27:1433-42. [PMID: 25233859 DOI: 10.1093/ajh/hpu135] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This critique is intended to provide background for the reader to evaluate the relative clinical utilities of brachial cuff systolic blood pressure (SBP) and its derivatives, including pulse pressure, central systolic pressure, central augmentation index (AI), and pulse pressure amplification (PPA). The critical question is whether the newer indicators add sufficient information to justify replacing or augmenting brachial cuff blood pressure (BP) data in research and patient care. Historical context, pathophysiology of variations in pulse wave transmission and reflection, issues related to measurement and model errors, statistical limitations, and clinical correlations are presented, along with new comparative data. Based on this overview, there is no compelling scientific or practical reason to replace cuff SBP with any of the newer indicators in the vast majority of clinical situations. Supplemental value for central SBP may exist in defining patients with exaggerated PPA ("spurious systolic hypertension"), managing cardiac and aortic diseases, and in studies of cardiovascular drugs, but there are no current standards for these possibilities.
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Affiliation(s)
- Joseph L Izzo
- Department of Medicine, State University of New York at Buffalo, Buffalo, New York, USA.
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24
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Rhee MY, Kim JH, Shin SJ, Gu N, Nah DY, Hong KS, Cho EJ, Sung KC. Estimation of 24-hour urinary sodium excretion using spot urine samples. Nutrients 2014; 6:2360-75. [PMID: 24955740 PMCID: PMC4073156 DOI: 10.3390/nu6062360] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 05/20/2014] [Accepted: 05/28/2014] [Indexed: 01/23/2023] Open
Abstract
The present study evaluated the reliability of equations using spot urine (SU) samples in the estimation of 24-hour urine sodium excretion (24-HUNa). Equations estimating 24-HUNa from SU samples were derived from first-morning SU of 101 participants (52.4 ± 11.1 years, range 24–70 years). Equations developed by us and other investigators were validated with SU samples from a separate group of participants (n = 224, 51.0 ± 10.9 years, range 24–70 years). Linear, quadratic, and cubic equations were derived from first-morning SU samples because these samples had a sodium/creatinine ratio having the highest correlation coefficient for 24-HUNa/creatinine ratio (r = 0.728, p < 0.001). In the validation group, the estimated 24-HUNa showed significant correlations with measured 24-HUNa values. The estimated 24-HUNa by the linear, quadratic, and cubic equations developed from our study were not significantly different from measured 24-HUNa, while estimated 24-HUNa by previously developed equations were significantly different from measured 24-HUNa values. The limits of agreement between measured and estimated 24-HUNa by six equations exceeded 100 mmol/24-hour in the Bland-Altman analysis. All equations showed a tendency of under- or over-estimation of 24-HUNa, depending on the level of measured 24-HUNa. Estimation of 24-HUNa from single SU by equations as tested in the present study was found to be inadequate for the estimation of an individual’s 24-HUNa.
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Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi 410-773, Korea.
| | - Ji-Hyun Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi 410-773, Korea.
| | - Sung-Joon Shin
- Division of Nephrology, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi 410-773, Korea.
| | - Namyi Gu
- Clinical Trial Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi 410-773, Korea.
| | - Deuk-Young Nah
- Cardiovascular Center, Dongguk University Gyeongju Hospital, 87 Dongdae-ro, Seokjang-dong, Gyeongju-si, Gyeongbuk 780-350, Korea.
| | - Kyung-Soon Hong
- Department of Cardiology, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon-si, Gangwon-do 200-704, Korea.
| | - Eun-Joo Cho
- Department of Cardiology, The Catholic University of Korea College of Medicine, 222 Banpodae-ro, Seocho-gu, Seoul 137-701, Korea.
| | - Ki-Chul Sung
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongro-Ku, Seoul 110-746, Korea.
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25
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Afsar B, Elsurer R. The relationship between central hemodynamics, morning blood pressure surge, glycemic control and sodium intake in patients with type 2 diabetes and essential hypertension. Diabetes Res Clin Pract 2014; 104:420-6. [PMID: 24780746 DOI: 10.1016/j.diabres.2014.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/25/2014] [Accepted: 03/20/2014] [Indexed: 12/11/2022]
Abstract
AIMS The current study aimed to investigate the relationship between morning blood pressure surge (MBPS), hemodynamic parameters, glycemic control and 24-h urinary sodium excretion (USE) in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS MBPS and central hemodynamic parameters were assessed from ambulatory blood pressure measurements. In addition to routine biochemistry, 24h urine collection was performed to measure protein, albumin and sodium excretion. RESULTS There were 146 (38%) patients with T2DM and 238 (72%) patients without T2DM (control group). Patients with T2DM had statistically higher MBPS compared with patients without T2DM (P<0.0001). In patients with T2DM, MBPS was correlated with HbA1c (rho=0.311, P<0.0001), 24h urinary sodium excretion (USE) (rho=0.292, P=0.004) and various hemodynamic parameters. Additionally, regression analysis showed that being male (P=0.006), the presence of coronary artery disease (P=0.023), HbA1c (P=0.012), and 24h USE (P=0.001) were independently related with log MBPS in T2DM patients. CONCLUSION This study demonstrated that T2DM was an independent risk factor for increased MBPS and MBPS was associated with central hemodynamic parameters. Additionally poor glycemic control and sodium intake were associated with worse MBPS in T2DM.
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Affiliation(s)
- Baris Afsar
- Konya Numune State Hospital, Department of Nephrology, Turkey.
| | - Rengin Elsurer
- Selcuklu Faculty of Medicine, Selcuk University, Department of Nephrology, Turkey
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26
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Kawamura M, Kawasaki T. Clinical application of the second morning urine method for estimating salt intake in patients with hypertension. Clin Exp Hypertens 2014; 37:89-96. [DOI: 10.3109/10641963.2014.913601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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27
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Marketou ME, Zacharis EA, Parthenakis F, Kochiadakis GE, Maragkoudakis S, Chlouverakis G, Vardas PE. Association of sodium and potassium intake with ventricular arrhythmic burden in patients with essential hypertension. ACTA ACUST UNITED AC 2013; 7:276-82. [PMID: 23659779 DOI: 10.1016/j.jash.2013.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hypertensive populations suffer from an increased susceptibility to ventricular arrhythmias and sudden cardiac death. A high-salt diet appears to be a major factor involved in cardiovascular complications in hypertension. We examined the relationship between dietary salt and potassium, as indicated by urinary sodium (UNa), urinary potassium (UK), and urinary sodium/potassium ratio (UNa/K), and the arrhythmic burden in patients with essential hypertension. METHODS We included 255 consecutive adult patients with well-controlled hypertension who were being followed in the hypertension outpatient clinic of a university tertiary hospital and complained of episodes of atypical chest pain and/or palpitations. All underwent 24-hour ambulatory electrocardiograph monitoring and their UNa, UK, and UNa/K ratio from 24-hour urinary excretion specimens were evaluated. RESULTS No significant correlation was found between premature supraventricular contractions and the parameters that were examined. However, the percentage of premature ventricular contractions (PVC%) showed a weak positive association with UNa (r = 0.2; P = .001) and a moderate negative association with UK (r = -0.396; P < .001). The partial correlation coefficient of PVC% with the UNa/UK ratio remained significant even after controlling for left ventricular mass index (r = 0.437; P < .001). CONCLUSIONS A higher UNa/UK excretion ratio is significantly associated with PVCs, indicating an increased susceptibility to ventricular arrhythmias even among hypertensives with well-controlled blood pressure. Our findings reinforce recommendations for dietary interventions in those populations.
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Affiliation(s)
- Maria E Marketou
- Department of Cardiology, University Hospital of Heraklion, Crete, Greece.
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28
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Liu YP, Thijs L, Kuznetsova T, Gu YM, Asayama K, Stolarz-Skrzypek K, Jin Y, Verhamme P, Struijker-Boudier HAJ, Staessen JA. Central systolic augmentation indexes and urinary sodium in a white population. Am J Hypertens 2013; 26:95-103. [PMID: 23382332 DOI: 10.1093/ajh/hps023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The association between cardiovascular health and salt intake remains controversial. The objective of our study was to assess the association between arterial stiffness and urinary sodium, both cross-sectionally and prospectively. METHODS In 630 participants (mean age 40.6 years; 51% women), randomly recruited from a Flemish population, we measured sodium and creatinine in 24-hour urine samples at baseline and follow-up (median, 9.7 years) and the carotid and aortic augmentation indexes (AIs) standardized to heart rate at follow-up only. RESULTS From baseline to follow-up, the urinary sodium concentration decreased (117.1 vs. 105.2 mmol/L; P < 0.0001), whereas 24-hour urinary sodium did not change significantly (166.5 vs. 171.5 mmol/L; P = 0.12). In multivariable-adjusted longitudinal analyses, a 40 mmol/L (~1 SD) increase in the urinary sodium concentration was independently and inversely associated with the carotid AI (effect size, -1.38 ± 0.66%; P = 0.04) and aortic AI (-1.54 ± 0.72%; P = 0.02). In cross-sectional analyses of follow-up data, these estimates were -1.26 ± 0.70% (P = 0.07) and -1.52 ± 0.76% (P = 0.04), respectively. In the longitudinal and cross-sectional analyses, the carotid and aortic AIs were unrelated to the 24-hour urinary excretion of sodium. CONCLUSIONS Our study showed an inverse association between the central arterial AIs and the urinary sodium concentration. Further research is required to consolidate our findings, to unravel the underlying mechanism, and to establish the role of renal vasodilatation in the maintenance of sodium balance.
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Affiliation(s)
- Yan-Ping Liu
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Sciences, University of Leuven, Belgium
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29
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García-Ortiz L, Recio-Rodríguez JI, Rodríguez-Sánchez E, Patino-Alonso MC, Agudo-Conde C, Rodríguez-Martín C, Castaño-Sánchez C, Runkle I, Gómez-Marcos MA. Sodium and potassium intake present a J-shaped relationship with arterial stiffness and carotid intima-media thickness. Atherosclerosis 2012; 225:497-503. [DOI: 10.1016/j.atherosclerosis.2012.09.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 09/24/2012] [Accepted: 09/24/2012] [Indexed: 01/27/2023]
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30
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Abstract
We examined major trends and patterns regarding sodium and potassium intake and the ratio of sodium and potassium in the diets of South Koreans. We used data from 24-h dietary recall data from 10,267, 8819 and 9264 subjects ages > or =2 years in the 1998, 2005 and 2009 Korean National Health and Nutrition Examination Surveys, respectively. Mean sodium intake did not change significantly between 1998 and 2009 (4.6 vs. 4.7 g per day), while potassium intake increased significantly (2.6 vs. 2.9 g per day (P<0.001)). The major dietary sodium sources were kimchi, salt, soy sauce and soybean paste, and most potassium came from unprocessed foods (white rice, vegetables, kimchi and fruits). About 50% of the participants consumed > or =4 g of sodium per capita per day. The proportion of respondents consuming four to six grams of potassium per capita per day increased from 10.3% in 1998 to 14.3% in 2009 (P<0.001), and the sodium-potassium ratio decreased from 1.88 to 1.71 (P<0.001). One major implication is that efforts to reduce sodium in processed foods will be ineffective and future efforts must focus on both education to reduce use of sodium in food preparation and sodium replacement in salt, possibly with potassium.
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31
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ROSA J, ŠOMLÓOVÁ Z, PETRÁK O, ŠTRAUCH B, INDRA T, ŠENITKO M, ZELINKA T, HOLAJ R, WIDIMSKÝ Jr J. Peripheral Arterial Stiffness in Primary Aldosteronism. Physiol Res 2012; 61:461-8. [DOI: 10.33549/physiolres.932344] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aldosterone overproduction increases arterial wall stiffness by accumulation of different types of collagen fibres and growth factors. Our previous studies showed that central (aortic) arterial stiffness is increased in primary aldosteronism (PA) independently of concomitant hypertension and that these changes might be reversible after successful adrenalectomy. There is limited data available on the potential impact of mineralocorticoid overproduction on the deterioration of peripheral arterial stiffness. The current study was thus aimed at investigating the effect of aldosterone overproduction on peripheral arterial stiffness assessed by peripheral (femoral-ankle) pulse wave velocity (PWV) in PA patients compared with essential hypertension (EH) patients. Forty-nine patients with confirmed PA and 49 patients with EH were matched for age, blood pressure, body mass index, lipid profile, and fasting glucose. PWV was obtained using the Sphygmocor applanation tonometer. Both peripheral and central PWV were significantly higher in PA patients compared to EH patients, while clinical blood pressures were similar. Plasma aldosterone level was the main predictor of peripheral PWV in PA. Our data indicate aldosterone overproduction in PA does not preferentially affect central arterial system. Fibroproliferative effect of higher aldosterone levels lead to alteration of central-elastic as well as peripheral-muscular arteries with subsequent increase in its stiffness.
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Affiliation(s)
- J. ROSA
- Third Department of Internal Medicine, General Faculty Hospital, First Medical Faculty, Charles University, Prague
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32
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Myrie SB, McKnight LL, King JC, McGuire JJ, Vliet BNV, Bertolo RF. Effects of a diet high in salt, fat, and sugar on telemetric blood pressure measurements in conscious, unrestrained adult Yucatan miniature swine (Sus scrofa). Comp Med 2012; 62:282-290. [PMID: 23043781 PMCID: PMC3415370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 11/10/2011] [Accepted: 02/15/2012] [Indexed: 06/01/2023]
Abstract
Radiotelemetry was used to evaluate diet-related elevation of blood pressure in adult Yucatan miniature swine. Systolic arterial blood pressure (SAP), diastolic atrial blood pressure (DAP), heart rate, and locomotor activity were assessed in 9- or 11-mo-old Yucatan miniature pigs fed a standard diet or a North American-type diet high in salt, fat, and sugar (HSFS). Compared with pigs fed standard diet, pigs fed HSFS diet showed markedly elevated SAP (132 ± 3 compared with 156 ± 6 mm Hg), whereas DAP was unchanged (92 ± 2 compared with 99 ± 5 mm Hg). In addition, all pigs were modestly sensitive to short-term changes in dietary salt, as indicated by a 6% to 7% response in blood pressure parameters. According to these data, the increase in SAP for pigs on the HSFS diet was too large to be explained by the NaCl content of the diet alone. We found no evidence of endothelial dysfunction, and the relaxation responses of isolated coronary arteries actually were enhanced in the HSFS group. In conclusion, in a Yucatan miniature pigs model chronically fed a HSFS diet, DAP did not increase, but SAP and pulse pressure appeared to be affected by high dietary levels of fat or sugar (or both).
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Affiliation(s)
| | | | - J Christopher King
- Division of BioMedical Sciences, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - John J McGuire
- Division of BioMedical Sciences, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Bruce N Van Vliet
- Division of BioMedical Sciences, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
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Abstract
High salt intake over long term is associated with increased incidence of arterial, predominantly systolic, hypertension and increased risk of cardiovascular diseases, e.g., stroke, heart failure, and renal insufficiency. High salt consumption is a vascular risk factor generating aortic stiffness and decreased vascular compliance leading to central blood pressure augmentation, higher cardiac load, and diminished diastolic perfusion. The development of heart failure can be a consequence of this sequelae. Randomized trials show a reduction in blood pressure with lower sodium intake. In long-term clinical trials, a reduction in cardiovascular morbidity and mortality has been demonstrated. Recommendations should emphasize the simultaneous reduction in sodium intake and increase in potassium intake.
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Affiliation(s)
- M Middeke
- Hypertoniezentrum München, München, Deutschland.
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