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Kim JH, Thiruvengadam R. Hypertension in an ageing population: Diagnosis, mechanisms, collateral health risks, treatments, and clinical challenges. Ageing Res Rev 2024; 98:102344. [PMID: 38768716 DOI: 10.1016/j.arr.2024.102344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
Ageing population is considerably increasing worldwide, which is considered to reflect an improved quality of life. However, longevity in the human lifespan has increased the burden of late-life illnesses including cancer, neurodegeneration, and cardiovascular dysfunction. Of these, hypertension is the most common condition with huge health risks, with an increased prevalence among the elderly. In this review, we outline the current guidelines for defining hypertension and examine the detailed mechanisms underlying the relationship between hypertension and ageing-related outcomes, including sodium sensitivity, arterial stiffness, endothelial dysfunction, isolated systolic hypertension, white coat effect, and orthostatic hypertension. As hypertension-related collateral health risk increases among the elderly, the available management strategies are necessary to overcome the clinical treatment challenges faced among elderly population. To improve longevity and reduce adverse health effects, potential approaches producing crucial information into new era of medicine should be considered in the prevention and treatment of hypertension among elderly population. This review provides an overview of mechanisms underlying hypertension and its related collateral health risk in elderly population, along with multiple approaches and management strategies to improve the clinical challenges among elderly population.
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Affiliation(s)
- Jin Hee Kim
- Department of Integrative Bioscience & Biotechnology, Sejong University, Seoul 05006, the Republic of Korea.
| | - Rekha Thiruvengadam
- Department of Integrative Bioscience & Biotechnology, Sejong University, Seoul 05006, the Republic of Korea
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2
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Elijovich F, Kirabo A, Laffer CL. Salt Sensitivity of Blood Pressure in Black People: The Need to Sort Out Ancestry Versus Epigenetic Versus Social Determinants of Its Causation. Hypertension 2024; 81:456-467. [PMID: 37767696 PMCID: PMC10922075 DOI: 10.1161/hypertensionaha.123.17951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Race is a social construct, but self-identified Black people are known to have higher prevalence and worse outcomes of hypertension than White people. This may be partly due to the disproportionate incidence of salt sensitivity of blood pressure in Black people, a cardiovascular risk factor that is independent of blood pressure and has no proven therapy. We review the multiple physiological systems involved in regulation of blood pressure, discuss what, if anything is known about the differences between Black and White people in these systems and how they affect salt sensitivity of blood pressure. The contributions of genetics, epigenetics, environment, and social determinants of health are briefly touched on, with the hope of stimulating further work in the field.
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Affiliation(s)
- Fernando Elijovich
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Cheryl L Laffer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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Jeong S, Hunter SD, Cook MD, Grosicki GJ, Robinson AT. Salty Subjects: Unpacking Racial Differences in Salt-Sensitive Hypertension. Curr Hypertens Rep 2024; 26:43-58. [PMID: 37878224 DOI: 10.1007/s11906-023-01275-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE OF REVIEW To review underlying mechanisms and environmental factors that may influence racial disparities in the development of salt-sensitive blood pressure. RECENT FINDINGS Our group and others have observed racial differences in diet and hydration, which may influence salt sensitivity. Dietary salt elicits negative alterations to the gut microbiota and immune system, which may increase hypertension risk, but little is known regarding potential racial differences in these physiological responses. Antioxidant supplementation and exercise offset vascular dysfunction following dietary salt, including in Black adults. Furthermore, recent work proposes the role of racial differences in exposure to social determinants of health, and differences in health behaviors that may influence risk of salt sensitivity. Physiological and environmental factors contribute to the mechanisms that manifest in racial differences in salt-sensitive blood pressure. Using this information, additional work is needed to develop strategies that can attenuate racial disparities in salt-sensitive blood pressure.
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Affiliation(s)
- Soolim Jeong
- Neurovascular Physiology Laboratory (NVPL), School of Kinesiology, Auburn University, Auburn, AL, 36849, USA
| | - Stacy D Hunter
- Department of Health & Human Performance, Texas State University, San Marcos, TX, 78666, USA
| | - Marc D Cook
- Department of Kinesiology, North Carolina Agriculture and Technology State University, Greensboro, NC, 27411, USA
| | - Gregory J Grosicki
- Biodynamics and Human Performance Center, Georgia Southern University (Armstrong Campus), Savannah, GA, 31419, USA
| | - Austin T Robinson
- Neurovascular Physiology Laboratory (NVPL), School of Kinesiology, Auburn University, Auburn, AL, 36849, USA.
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Almallouhi E, Nelson A, Cotsonis G, Harris W, Chimowitz MI, Turan TN. Ameliorating Racial Disparities in Vascular Risk Factor Management With Aggressive Medical Management in the SAMMPRIS Trial. Stroke 2023; 54:2235-2240. [PMID: 37534512 PMCID: PMC10526717 DOI: 10.1161/strokeaha.122.042055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/08/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The WASID trial (Warfarin-Aspirin Symptomatic Intracranial Disease) and the SAMMPRIS trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) evaluated optimal management of symptomatic intracranial atherosclerotic stenosis. The aim of this retrospective, observational study was to determine whether aggressive medical management used in the SAMMPRIS trial ameliorated disparities in risk factor control between Black and non-Black patients. METHODS The SAMMPRIS trial was a randomized controlled trial that enrolled patients with symptomatic intracranial atherosclerotic stenosis between November 2008 and April 2011. The frequency of risk factors at study entry (baseline) and mean levels of systolic blood pressure, diastolic blood pressure, LDL (low-density lipoprotein), hemoglobin A1c, and exercise level (quantified by physician-based assessment and counseling for exercise score) at baseline and at 1 year of follow-up were compared between Black (n=104) versus non-Black patients (n=347). RESULTS Significant differences at baseline in Black patients (listed first) versus non-Black patients were age (57.5 versus 61.0 years; P=0.004), hypertension (95.2% versus 87.5%; P=0.027), diabetes (52.9% versus 39.7%; P=0.017), mean diastolic blood pressure (82.4 versus 79.5 mm Hg; P=0.035), and mean physician-based assessment and counseling for exercise score (2.7 versus 3.3; P=0.002). The mean diastolic blood pressure and mean physician-based assessment and counseling for exercise scores at 1 year in Black versus non-Black patients were 74.7 versus 75.5 mm Hg (P=0.575) and 4.2 versus 4.1 (P=0.593), respectively. No disparities in other modifiable risk factors emerged at 1 year. CONCLUSIONS Significant differences in important risk factors (physical activity and diastolic blood pressure) at baseline between Black and non-Black patients resolved at 1 year, suggesting that aggressive medical management may have an important role in ameliorating disparities in risk factor control between Black and non-Black patients.
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Affiliation(s)
- Eyad Almallouhi
- Department of Neurology, Medical University of South Carolina, SC, USA
- Department of Neurosurgery, Medical University of South Carolina, SC, USA
| | - Ashley Nelson
- Department of Neurology, Medical University of South Carolina, SC, USA
| | | | - William Harris
- College of Medicine, Medical University of South Carolina, SC, USA
| | - Marc I. Chimowitz
- Department of Neurology, Medical University of South Carolina, SC, USA
| | - Tanya N. Turan
- Department of Neurology, Medical University of South Carolina, SC, USA
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Zhou E, Lei R, Tian X, Liu C, Guo J, Jin L, Jin H, Wang S, Cao L, Zhuoma C, Wang J, Luo B, Hu J. Association between salt sensitivity of blood pressure and the risk of hypertension in a Chinese Tibetan population. J Clin Hypertens (Greenwich) 2023; 25:453-462. [PMID: 37120829 PMCID: PMC10184482 DOI: 10.1111/jch.14663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 05/02/2023]
Abstract
Epidemiological studies have confirmed salt sensitivity as a crucial risk factor for the development of hypertension. However, few studies have investigated the association between salt sensitivity of blood pressure (SSBP) and hypertension in Chinese Tibetan population. Therefore, we conducted a cross-sectional study based on a Tibetan population to evaluate the association between SSBP and the risk of hypertension. Seven hundred and eighty-four participants with hypertension and 645 participants without hypertension were included from five villages in Tibetan Autonomous Region of Gannan during 2013-2014. The assessment of salt sensitivity (SS) and non-salt sensitivity (NSS) was performed according to mean arterial pressure (MAP) changes by the modified Sullivan's acute oral saline load and diuresis shrinkage test (MSAOSL-DST). Logistic regression models and restricted cubic models were used to examine the association between SSBP and hypertension. There were 554 (70.5%) salt-sensitive participants with hypertension and 412 (63.9%) salt-sensitive participants without hypertension in this study. Compared with individuals with NSS, individuals with SS had a significantly increased risk of hypertension, and the multiple-adjusted odds ratios were 2.582 with 95% confidence interval of 1.357-4.912. Furthermore, a significant linear trend was found between MAP changes and hypertension. Subgroup analyses showed significant and stronger associations between SSBP and the risk of hypertension in the older (age ≥ 55 years old), males and participants who took exercise less than 1 time per week. Our results suggest that SS is associated with an increased risk of hypertension in Tibetan population, indicating a need for clinicians dealing with SSBP to decrease the risk of hypertension.
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Affiliation(s)
- Erkai Zhou
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ruoyi Lei
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaoyu Tian
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ce Liu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jingzhe Guo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Limei Jin
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Hua Jin
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Shuxia Wang
- Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Liangjia Cao
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Cao Zhuoma
- People's Hospital of Xiahe County, Gannan Tibetan Autonomous Prefecture, Lanzhou, Gansu, China
| | - Jianzhong Wang
- School of Tibetan Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Bin Luo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jihong Hu
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
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Abstract
Several clinical and large population studies indicate that women are more salt-sensitive than men, yet the precise mechanisms by which the sexually dimorphic onset manifests remains incompletely understood. Here, we evaluate recent epidemiological data and highlight current knowledge from studies investigating sex-specific mechanisms of salt-sensitive blood pressure (SSBP). Emerging evidence indicates that women of all ethnicities are more salt-sensitive than men, at all ages both premenopausal and postmenopausal. However, menopause exacerbates severity and prevalence of SSBP, suggesting that female sex chromosomes predispose to and female sex hormones mitigate SSBP. Results from both human and rodent studies support the contribution of enhanced and inappropriate activation of the aldosterone-ECMR (endothelial cell mineralocorticoid receptor) axis promoting vascular dysfunction in females. Increases in adrenal response to angiotensin II, in association with higher ECMR expression and activation of endothelial ENaC (epithelial sodium channel) in females compared to males, are emerging as central players in the development of endothelial dysfunction and SSBP in females. Female sex increases the prevalence and susceptibility of SSBP and sex hormones and sex chromosome complement may exert antagonistic effects in the development of the female heightened SSBP.
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Affiliation(s)
- Candee T. Barris
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Jessica L. Faulkner
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Physiology Department, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Eric J. Belin de Chantemèle
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Department of Medicine (Cardiology), Medical College of Georgia at Augusta University, Augusta, GA, USA
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Zhang Z, Zhao L, Zhou X, Meng X, Zhou X. Role of inflammation, immunity, and oxidative stress in hypertension: New insights and potential therapeutic targets. Front Immunol 2023; 13:1098725. [PMID: 36703963 PMCID: PMC9871625 DOI: 10.3389/fimmu.2022.1098725] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Hypertension is regarded as the most prominent risk factor for cardiovascular diseases, which have become a primary cause of death, and recent research has demonstrated that chronic inflammation is involved in the pathogenesis of hypertension. Both innate and adaptive immunity are now known to promote the elevation of blood pressure by triggering vascular inflammation and microvascular remodeling. For example, as an important part of innate immune system, classically activated macrophages (M1), neutrophils, and dendritic cells contribute to hypertension by secreting inflammatory cy3tokines. In particular, interferon-gamma (IFN-γ) and interleukin-17 (IL-17) produced by activated T lymphocytes contribute to hypertension by inducing oxidative stress injury and endothelial dysfunction. However, the regulatory T cells and alternatively activated macrophages (M2) may have a protective role in hypertension. Although inflammation is related to hypertension, the exact mechanisms are complex and unclear. The present review aims to reveal the roles of inflammation, immunity, and oxidative stress in the initiation and evolution of hypertension. We envisage that the review will strengthen public understanding of the pathophysiological mechanisms of hypertension and may provide new insights and potential therapeutic strategies for hypertension.
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Affiliation(s)
| | | | | | - Xu Meng
- *Correspondence: Xianliang Zhou, ; Xu Meng,
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Jiang K, He T, Ji Y, Zhu T, Jiang E. The perspective of hypertension and salt intake in Chinese population. Front Public Health 2023; 11:1125608. [PMID: 36875386 PMCID: PMC9981806 DOI: 10.3389/fpubh.2023.1125608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/01/2023] [Indexed: 02/19/2023] Open
Abstract
Salt intake is too high nowadays. It has been widely recognized that there is a close relationship between hypertension (HTN) and dietary salt intake. Investigations reveal that long-term high salt intake, mainly sodium intake, induces a relevant increase in blood pressure in hypertensive and normotensive individuals. According to most scientific evidence, a diet with high salt intake in public increases cardiovascular risk, salted-related HTN, and other HTN-associated outcomes. Given the clinical importance, this review aims to present the prevalence of HTN and trends in salt intake in the Chinese population and will comprehensively discuss the risk factors, causes, and mechanisms of the association between salt intake and HTN. The review also highlights the education of Chinese people regarding salt intake and the cost-effectiveness of salt reduction from a global perspective. Finally, the review will emphasize the need to customize the unique Chinese practices to reduce salt intake and how awareness changes people's eating lifestyle and helps adopt diet salt reduction strategies.
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Affiliation(s)
- Kexin Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Tingting He
- Department of Basic Nursing, Henan Technical Institute, Zhengzhou, China
| | - Yongzhi Ji
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Tao Zhu
- Department of Geriatrics, Kaifeng Traditional Chinese Medicine Hospital, Kaifeng, China
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China.,Department of Scientific Research, Scope Research Institute of Electrophysiology, Kaifeng, China
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Ghazi L, Annabathula RV, Bello NA, Zhou L, Stacey RB, Upadhya B. Hypertension Across a Woman's Life Cycle. Curr Hypertens Rep 2022; 24:723-733. [PMID: 36350493 PMCID: PMC9893311 DOI: 10.1007/s11906-022-01230-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW We reviewed the effects of hypertension and the means to prevent and treat it across the spectrum of a woman's lifespan and identified gaps in sex-specific mechanisms contributing to hypertension in women that need to be addressed. RECENT FINDINGS Hypertension continues to be an important public health problem for women across all life stages from adolescence through pregnancy, menopause, and older age. There remain racial, ethnic, and socioeconomic differences in hypertension rates not only overall but also between the sexes. Blood pressure cutoffs during pregnancy have not been updated to reflect the 2017 ACC/AHA changes due to a lack of data. Additionally, the mechanisms behind hypertension development in menopause, including sex hormones and genetic factors, are not well understood. In the setting of increasing inactivity and obesity, along with an aging population, hypertension rates are increasing in women. Screening and management of hypertension throughout a women's lifespan are necessary to reduce the burden of cardiovascular disease, and further research to understand sex-specific hypertension mechanisms is needed.
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Affiliation(s)
- Lama Ghazi
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, USA
| | - Rahul V Annabathula
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, NC, 27157-1045, Winston-Salem, USA
| | - Natalie A Bello
- Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Li Zhou
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, NC, 27157-1045, Winston-Salem, USA
| | - Richard Brandon Stacey
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, NC, 27157-1045, Winston-Salem, USA
| | - Bharathi Upadhya
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, NC, 27157-1045, Winston-Salem, USA.
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
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Allen TS, Bhatia HS, Wood AC, Momin SR, Allison MA. State-of-the-Art Review: Evidence on Red Meat Consumption and Hypertension Outcomes. Am J Hypertens 2022; 35:679-687. [PMID: 35561332 DOI: 10.1093/ajh/hpac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
Hypertension (HTN) is a well-established risk factor for cardiovascular diseases (CVDs), including ischemic heart disease, stroke, heart failure, and atrial fibrillation. The prevalence of HTN, as well as mortality rates attributable to HTN, continue to increase, particularly in the United States and among Black populations. The risk of HTN involves a complex interaction of genetics and modifiable risk factors, including dietary patterns. In this regard, there is accumulating evidence that links dietary intake of red meat with a higher risk of poorly controlled blood pressure and HTN. However, research on this topic contains significant methodological limitations, which are described in the review. The report provided below also summarizes the available research reports, with an emphasis on processed red meat consumption and how different dietary patterns among certain populations may contribute to HTN-related health disparities. Finally, this review outlines potential mechanisms and provides recommendations for providers to counsel patients with evidence-based nutritional approaches regarding red meat and the risk of HTN, as well as CVD morbidity and mortality.
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Affiliation(s)
- Tara Shrout Allen
- Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego, San Diego, California, USA
| | - Harpreet S Bhatia
- Division of Cardiovascular Medicine, University of California, San Diego, San Diego, California, USA
| | - Alexis C Wood
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Shabnam R Momin
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew A Allison
- Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego, San Diego, California, USA
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Dhillon J, Jacobs AG, Ortiz S, Diaz Rios LK. A Systematic Review of Literature on the Representation of Racial and Ethnic Minority Groups in Clinical Nutrition Interventions. Adv Nutr 2022; 13:1505-1528. [PMID: 35108358 PMCID: PMC9526835 DOI: 10.1093/advances/nmac002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/29/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
The racial and ethnic disparities in diet-related chronic diseases are major concerns. This systematic review examines the extent to which diet-induced changes in health outcomes, such as cardiometabolic, inflammation, cancer, bone health, and kidney function outcomes, etc., have been reported and discussed by race or ethnicity in randomized trials with 2 or more diet arms that recruited both minority and non-Hispanic White groups. Databases (i.e., PubMed, Cochrane Library, and Web of Science) were searched up to August 2021. Thirty-four studies that discussed effects of defined dietary interventions on health outcomes by racial or ethnic minority group compared with non-Hispanic Whites were included in the systematic review (PROSPERO registration number: CRD42021229256). Acute trials and those with 1 diet arm that accounted for race or ethnicity in their analyses and studies that focused on a single racial or ethnic group were discussed separately. Most studies were conducted in Black compared with White adults testing effects of energy restriction, macronutrient modification, sodium reduction, or variations of the Dietary Approaches to Stop Hypertension (DASH) diet on cardiometabolic outcomes. There was limited focus on other minority groups. Evidence suggests greater blood pressure reduction for Black adults compared with Whites particularly with DASH (or similar) diets. Overall, there was limited consideration for group-specific eating patterns and diet acceptability. Overall risk of bias was low. With emerging precision nutrition initiatives that aim to optimize metabolic responses in population subgroups through tailored approaches, it is imperative to ensure adequate representation of racial and ethnic subgroups for addressing health disparities. Factors that help explain variability in responses such as socioecological context should be included and adequately powered. Given the racial and ethnic disparities in chronic diseases, studying the adoption, maintenance, and effectiveness of dietary interventions on health outcomes among different groups is critical for developing approaches that can mitigate diet-related health disparities.
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Affiliation(s)
| | | | - Sigry Ortiz
- Department of Molecular & Cell Biology, School of Natural Sciences, University of California Merced, Merced, CA, USA
| | - L Karina Diaz Rios
- Division of Agriculture and Natural Resources, University of California Merced, Merced, CA, USA
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Cheteu Wabo TM, Wu X, Sun C, Boah M, Ngo Nkondjock VR, Kosgey Cheruiyot J, Amporfro Adjei D, Shah I. Association of dietary calcium, magnesium, sodium, and potassium intake and hypertension: a study on an 8-year dietary intake data from the National Health and Nutrition Examination Survey. Nutr Res Pract 2022; 16:74-93. [PMID: 35116129 PMCID: PMC8784264 DOI: 10.4162/nrp.2022.16.1.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/17/2020] [Accepted: 05/11/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND/OBJECTIVES There has been an increased interest in determining calcium magnesium, sodium, and potassium's distinct effects on hypertension over the past decade, yet they simultaneously regulate blood pressure. We aimed at examining the association of dietary calcium, magnesium, sodium, and potassium independently and jointly with hypertension using National Health and Nutrition Examination Survey data from 2007 to 2014. MATERIALS/METHODS The associations were examined on a large cross-sectional study involving 16684 US adults aged>20 years, using multivariate analyses with logistical models. RESULTS Sodium and calcium quartiles assessed alone were not associated with hypertension. Potassium was negatively associated with hypertension in the highest quartile, 0.64 (95% confidence interval [CI], 0.48–0.87). When jointly assessed using the high and low cut-off points, low sodium and corresponding high calcium, magnesium, and potassium intake somewhat reduced the odds of hypertension 0.39 (95% CI, 0.20–0.76). The sodium-to-potassium ratio was positively associated with hypertension in the highest quartile1.50 (95% CI, 1.11–2.02). When potassium was adjusted for sodium intake and sodium-to-potassium ratio assessed among women, increased odds of hypertension were reported in the highest quartile as 2.02 (95% CI, 1.18–3.34) and 1.69 (95% CI, 1.12–2.57), respectively. The association of combined minerals on hypertension using dietary goals established that men meeting the reference intakes for calcium and exceeding for magnesium had reduced odds of hypertension 0.51 (95% CI, 0.30–0.89). Women exceeding the recommendations for both calcium and magnesium had the lower reduced odds of 0.30 (95% CI, 0.10–0.69). CONCLUSIONS Our results suggest that the studied minerals' association on hypertension is stronger when jointly assessed, mostly after gender stratification. As compared to men, women increased their risk of hypertension even with a low sodium intake. Women would also reasonably reduce their risk of developing hypertension by increasing calcium and magnesium intake. In comparison, men would somewhat be protected from developing hypertension with calcium intake meeting the dietary goals and magnesium exceeding the nutritional goals.
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Affiliation(s)
- Therese Martin Cheteu Wabo
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin 150081, China
- Department of Biomedical Sciences, Faculty of Sciences, University of Ngaoundéré, Ngaoundéré 454, Cameroon
| | - Xiaoyan Wu
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin 150081, China
| | - Changhao Sun
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin 150081, China
| | - Michael Boah
- Department of Epidemiology Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale TL 1883, Ghana
| | | | | | - Daniel Amporfro Adjei
- Department of Health Services Management, Harbin Medical University, Harbin 150081, China
| | - Imranulllah Shah
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin 150081, China
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Sahinoz M, Elijovich F, Ertuglu LA, Ishimwe J, Pitzer A, Saleem M, Mwesigwa N, Kleyman TR, Laffer CL, Kirabo A. Salt Sensitivity of Blood Pressure in Blacks and Women: A Role of Inflammation, Oxidative Stress, and Epithelial Na + Channel. Antioxid Redox Signal 2021; 35:1477-1493. [PMID: 34569287 PMCID: PMC8713266 DOI: 10.1089/ars.2021.0212] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Significance: Salt sensitivity of blood pressure (SSBP) is an independent risk factor for mortality and morbidity due to cardiovascular disease, and disproportionately affects blacks and women. Several mechanisms have been proposed, including exaggerated activation of sodium transporters in the kidney leading to salt retention and water. Recent Advances: Recent studies have found that in addition to the renal epithelium, myeloid immune cells can sense sodium via the epithelial Na+ channel (ENaC), which leads to activation of the nicotinamide adenine dinucleotide phosphate oxidase enzyme complex, increased fatty acid oxidation, and production of isolevuglandins (IsoLGs). IsoLGs are immunogenic and contribute to salt-induced hypertension. In addition, aldosterone-mediated activation of ENaC has been attributed to the increased SSBP in women. The goal of this review is to highlight mechanisms contributing to SSBP in blacks and women, including, but not limited to increased activation of ENaC, fatty acid oxidation, and inflammation. Critical Issues: A critical barrier to progress in management of SSBP is that its diagnosis is not feasible in the clinic and is limited to expensive and laborious research protocols, which makes it difficult to investigate. Yet without understanding the underlying mechanisms, this important risk factor remains without treatment. Future Directions: Further studies are needed to understand the mechanisms that contribute to differential blood pressure responses to dietary salt and find feasible diagnostic tools. This is extremely important and may go a long way in mitigating the racial and sex disparities in cardiovascular outcomes. Antioxid. Redox Signal. 35, 1477-1493.
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Affiliation(s)
- Melis Sahinoz
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fernando Elijovich
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lale A Ertuglu
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanne Ishimwe
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashley Pitzer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mohammad Saleem
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naome Mwesigwa
- Department of Medicine and Dentistry, Kampala International University, Kampala, Uganda
| | - Thomas R Kleyman
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Cell Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cheryl L Laffer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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14
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Association of Circulating Biomarkers of lnc-IGSF3-1:1, SCOC-AS1, and SLC8A1-AS1 with Salt Sensitivity of Blood Pressure in Chinese Population. J Cardiovasc Transl Res 2021; 15:906-917. [PMID: 34855149 DOI: 10.1007/s12265-021-10190-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/16/2021] [Indexed: 01/24/2023]
Abstract
Accumulating evidence suggested that long non-coding RNAs (lncRNAs) could play biological roles in cardiovascular diseases. We investigated whether lncRNAs can serve as biomarkers for salt sensitivity of blood pressure (SSBP). Participants were divided into salt-sensitive (SS) and salt-resistant (SR) ones by oral saline test. LncRNAs were tested by microarray (N = 20) and two-stage qRT-PCR (N = 89 and 228). We identified five differently expressed lncRNAs (lnc-IGSF3-1:1, SCOC-AS1, SLC8A1-AS1, KCNQ1OT1, and lnc-GNG-10-3:1) between SS and SR. In single-lncRNA analyses, lnc-IGSF3-1:1 displayed better diagnostic performance in hypertensive patients (AUC = 0.840), while SCOC-AS1 in normotensive (AUC = 0.810). In multi-lncRNA analyses, lnc-IGSF3-1:1 + SCOC-AS1 + SLC8A1-AS1 combination showed the best diagnostic performance in hypertensive (AUC = 0.853) and normotensive groups (AUC = 0.873). We constructed a lncRNA-mRNA-GO-KEGG-disease network by bioinformatic analysis; lnc-IGSF3-1:1 and SLC8A1-AS1 were identified as hub biomarkers. Our findings suggest that lnc-IGSF3-1:1, SCOC-AS1, and SLC8A1-AS1 may represent as genetic susceptible biomarkers for SSBP, and had different SS diagnostic performance in hypertensive patients and normotensive individuals.
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15
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Robinson AT, Wenner MM, Charkoudian N. Differential influences of dietary sodium on blood pressure regulation based on race and sex. Auton Neurosci 2021; 236:102873. [PMID: 34509133 PMCID: PMC8627459 DOI: 10.1016/j.autneu.2021.102873] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/19/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
There are clear differences between men and women, and differences among races, in the incidence and prevalence of hypertension. Furthermore, there is extensive inter-individual variability among humans in the extent to which sodium ingestion alters blood pressure. Orthostatic intolerance and orthostatic hypotension are more common in women; these are often treated with a high salt diet, which has variable efficacy in increasing blood volume and blood pressure. Conversely, people with certain forms of hypertension are often counseled to decrease their sodium intake. Non-Hispanic Black men and women have higher rates of hypertension compared to non-Hispanic White men and women and other racial/ethnic groups. In aggregate, Black women appear to have better orthostatic tolerance than White women. In the present paper, we summarize and evaluate the current evidence for mechanisms of blood pressure regulation in men and women, as well as differences between Black and White groups, with a focus on cardiovascular responses to salt and differences among these groups. We also provide a brief review of factors that are not traditionally considered to be "biological" - such as socio-economic disparities resulting from historic and contemporary inequity across racial groups. These non-biological factors have direct and substantial influences on cardiovascular mechanisms, as well as implications for the influences of salt and sodium intake on blood pressure and cardiovascular health. We conclude that both biological and socio-economic factors provide critical modulating influences when considering the impacts of sodium on cardiovascular health as functions of race and sex.
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Affiliation(s)
- Austin T Robinson
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, AL 36849, United States of America.
| | - Megan M Wenner
- Women's Cardiovascular Research Laboratory, Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19713, United States of America
| | - Nisha Charkoudian
- Thermal & Mountain Medicine Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, United States of America
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16
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Campesi I, Montella A, Seghieri G, Franconi F. The Person's Care Requires a Sex and Gender Approach. J Clin Med 2021; 10:4770. [PMID: 34682891 PMCID: PMC8541070 DOI: 10.3390/jcm10204770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/15/2022] Open
Abstract
There is an urgent need to optimize pharmacology therapy with a consideration of high interindividual variability and economic costs. A sex-gender approach (which considers men, women, and people of diverse gender identities) and the assessment of differences in sex and gender promote global health, avoiding systematic errors that generate results with low validity. Care for people should consider the single individual and his or her past and present life experiences, as well as his or her relationship with care providers. Therefore, intersectoral and interdisciplinary studies are urgently required. It is desirable to create teams made up of men and women to meet the needs of both. Finally, it is also necessary to build an alliance among regulatory and ethic authorities, statistics, informatics, the healthcare system and providers, researchers, the pharmaceutical and diagnostic industries, decision makers, and patients to overcome the gender gap in medicine and to take real care of a person in an appropriate manner.
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Affiliation(s)
- Ilaria Campesi
- Laboratory of Sex-Gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, Italy;
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Andrea Montella
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Giuseppe Seghieri
- Department of Epidemiology, Regional Health Agency of Tuscany, 50124 Florence, Italy;
| | - Flavia Franconi
- Laboratory of Sex-Gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, Italy;
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17
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He J, Huang JF, Li C, Chen J, Lu X, Chen JC, He H, Li JX, Cao J, Chen CS, Bazzano LA, Hu D, Kelly TN, Gu DF. Sodium Sensitivity, Sodium Resistance, and Incidence of Hypertension: A Longitudinal Follow-Up Study of Dietary Sodium Intervention. Hypertension 2021; 78:155-164. [PMID: 33896191 DOI: 10.1161/hypertensionaha.120.16758] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.).,Tulane University Translational Sciences Institute, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.)
| | - Jian-Feng Huang
- Department of Epidemiology and Key Laboratory of Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China (J.-F.H., X.L., J.-C.C., J.-X.L., J. Cao, D.-F.G.)
| | - Changwei Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.).,Tulane University Translational Sciences Institute, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.)
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.).,Tulane University Translational Sciences Institute, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.)
| | - Xiangfeng Lu
- Department of Epidemiology and Key Laboratory of Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China (J.-F.H., X.L., J.-C.C., J.-X.L., J. Cao, D.-F.G.)
| | - Ji-Chun Chen
- Department of Epidemiology and Key Laboratory of Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China (J.-F.H., X.L., J.-C.C., J.-X.L., J. Cao, D.-F.G.)
| | - Hua He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.).,Tulane University Translational Sciences Institute, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.)
| | - Jian-Xin Li
- Department of Epidemiology and Key Laboratory of Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China (J.-F.H., X.L., J.-C.C., J.-X.L., J. Cao, D.-F.G.)
| | - Jie Cao
- Department of Epidemiology and Key Laboratory of Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China (J.-F.H., X.L., J.-C.C., J.-X.L., J. Cao, D.-F.G.)
| | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.).,Tulane University Translational Sciences Institute, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.)
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.).,Tulane University Translational Sciences Institute, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.)
| | - Dongsheng Hu
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Guangdong, China (D.H.)
| | - Tanika N Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.).,Tulane University Translational Sciences Institute, New Orleans, LA (J.H., C.L., J. Chen, H.H., C.-S.C., L.A.B., T.N.K.)
| | - Dong-Feng Gu
- Department of Epidemiology and Key Laboratory of Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China (J.-F.H., X.L., J.-C.C., J.-X.L., J. Cao, D.-F.G.)
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18
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Kurtz TW, DiCarlo SE, Pravenec M, Morris RC. No evidence of racial disparities in blood pressure salt sensitivity when potassium intake exceeds levels recommended in the US dietary guidelines. Am J Physiol Heart Circ Physiol 2021; 320:H1903-H1918. [PMID: 33797275 DOI: 10.1152/ajpheart.00980.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
On average, black individuals are widely believed to be more sensitive than white individuals to blood pressure (BP) effects of changes in salt intake. However, few studies have directly compared the BP effects of changing salt intake in black versus white individuals. In this narrative review, we analyze those studies and note that when potassium intake substantially exceeds the recently recommended US dietary goal of 87 mmol/day, black adults do not appear more sensitive than white adults to BP effects of short-term or long-term increases in salt intake (from an intake ≤50 mmol/day up to 150 mmol/day or more). However, with lower potassium intakes, racial differences in salt sensitivity are observed. Mechanistic studies suggest that racial differences in salt sensitivity are related to differences in vascular resistance responses to changes in salt intake mediated by vasodilator and vasoconstrictor pathways. With respect to cause and prevention of racial disparities in salt sensitivity, it is noteworthy that 1) on average, black individuals consume less potassium than white individuals and 2) consuming supplemental potassium bicarbonate, or potassium rich foods can prevent racial disparities in salt sensitivity. However, the new US dietary guidelines reduced the dietary potassium goal well below the amount associated with preventing racial disparities in salt sensitivity. These observations should motivate research on the impact of the new dietary potassium guidelines on racial disparities in salt sensitivity, the risks and benefits of potassium-containing salt substitutes or supplements, and methods for increasing consumption of foods rich in nutrients that protect against salt-induced hypertension.
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Affiliation(s)
- Theodore W Kurtz
- Department of Laboratory Medicine, University of California, San Francisco, California
| | - Stephen E DiCarlo
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Michal Pravenec
- Institute of Physiology, Czech Academy of Sciences, Prague, Czech Republic
| | - R Curtis Morris
- Department of Medicine, University of California, San Francisco, California
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19
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Galaviz KI, Varughese R, Agan BK, Marconi VC, Chu X, Won SH, Ganesan A, Ali MK, Colasanti J. The Intersection of HIV, Diabetes, and Race: Exploring Disparities in Diabetes Care among People Living with HIV. J Int Assoc Provid AIDS Care 2020; 19:2325958220904241. [PMID: 32162997 PMCID: PMC7068738 DOI: 10.1177/2325958220904241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 12/08/2019] [Accepted: 01/08/2020] [Indexed: 01/05/2023] Open
Abstract
In a setting of universal health care access, we compared diabetes control between Caucasians and African Americans (AA) living with HIV. This was a cross-sectional analysis of data from a cohort study among military members living with HIV and diabetes. Using adjusted logistic regression models, we compared proportions of Caucasians and AA meeting the following diabetes treatment goals: hemoglobin A1c <7.0%, blood pressure (BP) <140/90 mm Hg, low density lipoprotein cholesterol <100 mg/dL, and not smoking. We included 107 Caucasian (mean age 37 years) and 126 AA (mean age 33 years) participants. A similar proportion of Caucasians and AA were prescribed diabetes (∼60%) and BP (∼80%) medications. Yet, more Caucasians met the BP treatment goal (77% [54%, 90%]) than AA (61% [36%, 82%]). Thus, more Caucasians met the combined A1c, BP, and cholesterol goals for diabetes control (25% [10%, 49%]) than AA (13% [5%, 31%]). Despite having equal access to health care, AA in this study have poorer diabetes control than Caucasians.
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Affiliation(s)
- Karla I. Galaviz
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rincy Varughese
- Infectious Disease Section, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Vincent C. Marconi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Infectious Disease Section, Atlanta VA Medical Center, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Infectious Disease Program, Grady Health System, Atlanta, GA, USA
| | - Xiuping Chu
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Seung Hyun Won
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Mohammed K. Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan Colasanti
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Infectious Disease Program, Grady Health System, Atlanta, GA, USA
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20
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Clemmer JS, Faulkner JL, Mullen AJ, Butler KR, Hester RL. Sex-specific responses to mineralocorticoid receptor antagonism in hypertensive African American males and females. Biol Sex Differ 2019; 10:24. [PMID: 31072402 PMCID: PMC6507140 DOI: 10.1186/s13293-019-0238-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/16/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND African Americans (AA) develop hypertension (HTN) at an earlier age, have a greater frequency and severity of HTN, and greater prevalence of uncontrolled HTN as compared to the white population. Mineralocorticoid antagonists have been shown to be very effective in treating uncontrolled HTN in both AA and white patients, but sex-specific responses are unclear. METHODS We evaluated the sex-specific impact of mineralocorticoid antagonism in an AA population. An AA cohort (n = 1483) from the Genetic Epidemiology Network of Arteriopathy study was stratified based on sex and whether they were taking spironolactone, a mineralocorticoid antagonist, in their antihypertensive regimen. RESULTS As compared to AA women not prescribed a mineralocorticoid antagonist, AA women taking spironolactone (n = 9) had lower systolic and diastolic blood pressure despite having a similar number of antihypertensive medications. The proportion of AA women with uncontrolled HTN was significantly less for patients taking spironolactone than for patients not prescribed spironolactone. Interestingly, none of these associations were found in the AA males or in white females. CONCLUSIONS Our data suggests that spironolactone is particularly effective in reducing blood pressure and controlling HTN in AA women. Further research into the impact of this therapy in this underserved and understudied minority is warranted.
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Affiliation(s)
- John S Clemmer
- Department of Physiology and Biophysics, Center for Computational Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216-4505, USA.
| | - Jessica L Faulkner
- Vascular Biology Center, Medical College of Georgia, Augusta University, Augusta, GA, 30912-5563, USA
| | - Alex J Mullen
- Department of Physiology and Biophysics, Center for Computational Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216-4505, USA
| | - Kenneth R Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA
| | - Robert L Hester
- Department of Physiology and Biophysics, Center for Computational Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216-4505, USA.,Department of Data Sciences, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA
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21
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Sodium sensitivity of blood pressure in Chinese populations. J Hum Hypertens 2019; 34:94-107. [PMID: 30631129 DOI: 10.1038/s41371-018-0152-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/15/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
Abstract
Hypertension is an enormous public-health challenge in the world due to its high prevalence and consequent increased cardiovascular disease morbidity and mortality. Observational epidemiologic studies and clinical trials have demonstrated a causal relationship between sodium intake and elevated blood pressure (BP). However, BP changes in response to sodium intervention vary among individuals-a trait called sodium sensitivity. This paper aims to review the recent advances in sodium-sensitivity research in Chinese and other populations. Older age, female gender, and black race are associated with high sodium sensitivity. Both genetic and environmental factors influence BP sodium sensitivity. Physical activity and dietary potassium intake are associated with reduced sodium sensitivity while obesity, metabolic syndrome, and elevated BP are associated with increased sodium sensitivity. Familial studies have documented a moderate heritability of sodium sensitivity. Candidate gene association studies, genome-wide association studies, whole-exome, and whole-genome sequencing studies have been conducted to elucidate the genomic mechanisms of sodium sensitivity. The Genetic Epidemiology Network of Salt Sensitivity (GenSalt) study, the largest family-based feeding study to date, was conducted among 1906 Han Chinese in rural northern China. This study showed that ~32.4% of Chinese adults were sodium sensitive. Additionally, several genetic variants were found to be associated with sodium sensitivity. Findings from the GenSalt Study and others indicate that sodium sensitivity is a reproducible trait and both lifestyle factors and genetic variants play a role in this complex trait. Discovering biomarkers and underlying mechanisms for sodium sensitivity will help to develop individualized intervention strategies for hypertension.
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22
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Faulkner JL, Harwood D, Bender L, Shrestha L, Brands MW, Morwitzer MJ, Kennard S, Antonova G, de Chantemèle EJB. Lack of Suppression of Aldosterone Production Leads to Salt-Sensitive Hypertension in Female but Not Male Balb/C Mice. Hypertension 2018; 72:1397-1406. [PMID: 30571230 PMCID: PMC6309424 DOI: 10.1161/hypertensionaha.118.11303] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Clinical studies indicate that salt-sensitive hypertension is more prevalent in women than in men. However, animal models of salt sensitivity have primarily focused on the mechanisms of salt sensitivity in male animals; therefore, elucidation of these mechanisms in female animal models is needed. We have previously shown that female Balb/C mice have higher aldosterone synthase expression and aldosterone production than males. We hypothesized that female Balb/C mice develop salt-sensitive increases in blood pressure. Seven-day feeding of a 4% NaCl high-salt (HS) diet increased blood pressure in female mice without altering blood pressure in males. Females on an HS diet displayed no apparent increases in sodium retention as assessed by 24-hour urine collection, sodium balance measure, and saline loading excretion analysis. Females on an HS diet exhibited lower renin-angiotensin system activity (plasma Ang II [angiotensin II], plasma renin activity, and ACE [angiotensin-converting enzyme] activity) compared with males but developed a salt-induced elevation in adrenal aldosterone synthase expression and retained higher aldosterone levels than males on HS. This resulted in a higher aldosterone/plasma renin activity ratio in females compared with males on HS feeding. Adrenal mRNA expression of angiotensinogen and leptin receptor was increased in female mice on an HS diet. HS impaired endothelium-dependent relaxation in female mice only. MR (mineralocorticoid receptor) inhibition (eplerenone) restored blood pressure and endothelial function in females on an HS diet. Collectively, these data indicate that Balb/C mice develop sex-discrepant salt-sensitive hypertension likely via aldosterone-MR-mediated mechanisms involving impaired endothelium-dependent relaxation in females only. This study presents the first model of spontaneous sex-specific salt sensitivity, which mimics the human pathology.
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Affiliation(s)
- Jessica L Faulkner
- Vascular Biology Center, Medical College of Georgia at Augusta University
| | - Daisy Harwood
- Vascular Biology Center, Medical College of Georgia at Augusta University
| | - Lily Bender
- Vascular Biology Center, Medical College of Georgia at Augusta University
| | - Lenee Shrestha
- Vascular Biology Center, Medical College of Georgia at Augusta University
| | - Michael W. Brands
- Physiology Department, Medical College of Georgia at Augusta University
| | - M. Jane Morwitzer
- Vascular Biology Center, Medical College of Georgia at Augusta University
| | - Simone Kennard
- Vascular Biology Center, Medical College of Georgia at Augusta University
| | - Galina Antonova
- Vascular Biology Center, Medical College of Georgia at Augusta University
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23
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Yan Y, Zhang T, Li S, Liu Y, Bazzano L, He J, Mi J, Chen W. Black-White Difference in the Impact of Long-Term Blood Pressure From Childhood on Adult Renal Function: The Bogalusa Heart Study. Am J Hypertens 2018; 31:1300-1306. [PMID: 30010953 DOI: 10.1093/ajh/hpy109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/10/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To examine racial difference in the impact of long-term burden of blood pressure (BP) from childhood on adult renal function between middle-aged blacks and whites. METHODS The study cohort consisted of 1,646 whites and 866 blacks aged 20-51 years at follow-up who had BP measured at least 4 times since childhood, with a mean follow-up period of 25.3 years. The area under the curve (AUC) was calculated as a measure of long-term burden of BP from childhood to adulthood. Estimated glomerular filtration rate (eGFR) was calculated based on serum creatinine to assess renal function in adulthood. RESULTS Black vs. white adults had significantly higher values of eGFR and long-term burden of systolic BP for both males and females. In multivariable linear regression analyses, adjusting for sex, adult age, body mass index, smoking, and alcohol use, adult eGFR was significantly and negatively associated with adult systolic BP (standardized regression coefficient [β] = -0.10, P = 0.005) and diastolic BP (β = -0.11, P = 0.003) in blacks, but not in whites. The total BP AUC values were also significantly and negatively associated with adult eGFR (β = -0.10, P = 0.005 for systolic BP and β = -0.09, P = 0.013 for diastolic BP) in blacks only. Childhood BP was not significantly associated with adult eGFR in blacks and whites. CONCLUSIONS These findings suggest that black-white disparities in the influence of elevated BP on the development of renal dysfunction occur in middle adulthood, which underscores the importance of BP control in the black population.
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Affiliation(s)
- Yinkun Yan
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Tao Zhang
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Shengxu Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Yang Liu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Jie Mi
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Wei Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Abstract
PURPOSE OF REVIEW Low-grade inflammation drives elevations in blood pressure (BP) and consequent target organ damage in diverse experimental models of hypertension. Here, we discuss recent advances elucidating immune-mediated mechanisms of BP elevation and associated target organ damage. RECENT FINDINGS Inflammatory mediators produced by immune cells or target organs act on the kidney, vasculature, skin, and nervous system to modulate hypertension. For example, cells of the innate immune system, including monocytes, neutrophils, and dendritic cells (DCs), can all promote BP elevation via actions in the vasculature and kidney. Macrophages expressing VEGF-C impact non-osmotic sodium storage in the skin that in turn regulates salt sensitivity. Within the adaptive immune system, activated T cells can secrete tumor necrosis factor-alpha (TNF-α), interleukin-17a (IL-17a), and interferon-gamma (IFN-γ), each of which has augmented BP and renal damage in pre-clinical models. Inversely, deficiency of IL-17a in mice blunts the hypertensive response and attenuates renal sodium retention via a serum- and glucocorticoid-regulated kinase 1 (SGK1)-dependent pathway. Linking innate and adaptive immune responses, dendritic cells activated by augmented extracellular sodium concentrations stimulate T lymphocytes to produce pro-hypertensive cytokines. By contrast, regulatory T cells (Tregs) can protect against hypertension and associated kidney injury. Rodent studies reveal diverse mechanisms via which cells of the innate and adaptive immune systems drive blood pressure elevation by altering the inflammatory milieu in the kidney, vasculature, and brain.
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Booth III JN, Li M, Shimbo D, Hess R, Irvin MR, Kittles R, Wilson JG, Jorde LB, Cheung AK, Lange LA, Lange EM, Yano Y, Muntner P, Bress AP. West African Ancestry and Nocturnal Blood Pressure in African Americans: The Jackson Heart Study. Am J Hypertens 2018. [PMID: 29528363 DOI: 10.1093/ajh/hpy038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND African Americans have a higher prevalence of nocturnal hypertension and nondipping blood pressure than European Americans, but the genetic contribution to these racial differences remains unclear. We assessed the association of the percentage West African genetic ancestry with nocturnal hypertension and nondipping blood pressure in 932 African Americans from the Jackson Heart Study. METHODS Using percentage West African ancestry determined from 389 ancestry informative markers, participants were categorized into tertiles (tertile 1 [low]: <79.3%, tertile 2: ≥79.3-86.3%, and tertile 3 [high]: >86.3%). Nocturnal hypertension was defined as mean nighttime (midnight-6 am) systolic (SBP)/diastolic blood pressure ≥120/70 mm Hg. Nondipping blood pressure was defined as mean nighttime-to-daytime (10 am-8 pm) SBP ratio >0.90. RESULTS Nocturnal hypertension was present in 57.9% of participants; 66.6% had nondipping blood pressure. The mean age was 59.4 years, 32.8% were male, and 56.0% were taking antihypertensive medication. The prevalence ratios (95% confidence interval) adjusted for age, sex, cardiovascular disease risk factors, and socioeconomic and psychosocial factors comparing participants with moderate and high to those with low percentage West African ancestry for nocturnal hypertension were 0.98 (0.87-1.10) and 0.95 (0.84-1.08), respectively, and for nondipping blood pressure was 0.96 (0.86-1.07) and 0.98 (0.88-1.09), respectively. CONCLUSIONS West African ancestry was not associated with nocturnal hypertension and nondipping blood pressure among African Americans. While rare genetic variants cannot be ruled out, these data highlight the need to better understand how environmental and behavioral factors contribute to differences in nocturnal blood pressure among African Americans compared with European Americans.
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Affiliation(s)
- John N Booth III
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Man Li
- Divsion of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University, New York, New York, USA
| | - Rachel Hess
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rick Kittles
- Division of Health Equities, Department of Population Sciences, City of Hope, Pasadena, California, USA
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Lynn B Jorde
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alfred K Cheung
- Divsion of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Leslie A Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ethan M Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Yuichiro Yano
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam P Bress
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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Effect of Salt Intake on Plasma and Urinary Uric Acid Levels in Chinese Adults: An Interventional Trial. Sci Rep 2018; 8:1434. [PMID: 29362390 PMCID: PMC5780523 DOI: 10.1038/s41598-018-20048-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/08/2018] [Indexed: 01/30/2023] Open
Abstract
Uric acid (UA) has been proposed as an important risk factor for cardiovascular and renal morbidity. We conducted an interventional trial to assess effects of altered salt intake on plasma and urine UA levels and the relationship between UA levels and salt sensitivity in humans. Ninety subjects (18–65 years old) were sequentially maintained on a normal diet for 3 days at baseline, a low-salt diet for 7 days (3.0 g/day, NaCl), and a high-salt diet for an additional 7 days (18.0 g/day of NaCl). Plasma UA levels significantly increased from baseline to low-salt diet and decreased from low-salt to high-salt diet. By contrast, daily urinary levels of UA significantly decreased from baseline to low-salt diet and increased from low-salt to high-salt diet. The 24 h urinary sodium excretions showed inverse correlation with plasma UA and positive correlation with urinary UA excretions. Additionally, salt-sensitive subjects presented significantly higher plasma UA changes in comparison to salt-resistant subjects, and a negative correlation was observed between degree of salt sensitivity and plasma UA difference. The present study indicates that variations in dietary salt intake affect plasma and urine UA levels, and plasma UA may be involved in pathophysiological process of salt sensitivity.
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Hu J, Zhao L, Thompson B, Zhang Y, Wu Y. Effects of salt substitute on home blood pressure differs according to age and degree of blood pressure in hypertensive patients and their families. Clin Exp Hypertens 2018; 40:664-672. [PMID: 29400576 DOI: 10.1080/10641963.2018.1425415] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is known that home blood pressure (HBP) is a more reliable assessment of hypertension treatments than clinical blood pressure (BP). Despite this, HBP response to a salt substitute has only been evaluated by one study which, did not look at the salt substitute's effect on family members and did not analyze by age, gender, or BP degree. The aim of this current study was to assess the effects of a low-sodium and high-potassium salt substitute on HBP among hypertensive patients and their family members. METHODS A total of 220 households (including 220 hypertensive patients and 380 their families) were randomly assigned to the regular salt or salt substitute groups. HBP was measured at the beginning, 3rd, 6th, and 12th months. Among the patients (n = 220), only home systolic blood pressure (HSBP) was significantly reduced, by an adjusted baseline BP of 4.2 mm Hg (95% CI: 1.3-7.0 mm Hg), in the salt substitute group compared with those in the regular salt group at each visit (all P < 0.05). There were no detectable differences between groups for home diastolic blood pressure (HDBP) at any visit. Among the family members, HSBP and HDBP were not significantly different between the groups. Furthermore, Individuals ≥60 years old, hypertensive patients with stage-2 hypertension, family members with hypertension, and women experienced greater HSBP reduction. CONCLUSIONS Older subjects, those with higher blood pressure, and women experienced greater home blood pressure reduction from the salt substitute compared to regular salt.
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Affiliation(s)
- Jihong Hu
- a Department of Epidemiology , Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
- c Public Health School, Gansu University of Chinese Medicine , Gansu , China
| | - Liancheng Zhao
- a Department of Epidemiology , Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Brian Thompson
- d Department of Environmental Health Sciences , Yale University School of Public Health , New Haven , CT , USA
| | - Yawei Zhang
- d Department of Environmental Health Sciences , Yale University School of Public Health , New Haven , CT , USA
- e Department of Surgery , Yale University School of Medicine , New Haven , CT , USA
| | - Yangfeng Wu
- a Department of Epidemiology , Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
- b Department of Epidemiology , Public Health School, Peking University Health Science Center , Beijing , China
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28
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Abstract
The link between inappropriate salt retention in the kidney and hypertension is well recognized. However, growing evidence suggests that the immune system can play surprising roles in sodium homeostasis, such that the study of inflammatory cells and their secreted effectors has provided important insights into salt sensitivity. As part of the innate immune system, myeloid cells have diverse roles in blood pressure regulation, ranging from prohypertensive actions in the kidney, vasculature, and brain, to effects in the skin that attenuate blood pressure elevation. In parallel, T lymphocyte subsets, as key constituents of the adaptive immune compartment, have variable effects on renal sodium handling and the hypertensive response, accruing from the functions of the cytokines that they produce. Conversely, salt can directly modulate the phenotypes of myeloid and T cells, illustrating bidirectional regulatory mechanisms through which sodium and the immune system coordinately impact blood pressure. This review details the complex interplay between myeloid cells, T cells, and salt in the pathogenesis of essential hypertension.
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Affiliation(s)
- A Justin Rucker
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27710, USA; .,Durham Veterans Affairs Medical Center, Durham, North Carolina 27705, USA
| | - Nathan P Rudemiller
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27710, USA; .,Durham Veterans Affairs Medical Center, Durham, North Carolina 27705, USA
| | - Steven D Crowley
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27710, USA; .,Durham Veterans Affairs Medical Center, Durham, North Carolina 27705, USA
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Abstract
Hypertension is a major independent risk factor for cardiovascular disease for all ethnic and racial groups. Compared with other lifestyle and metabolic risk factors, hypertension is the leading cause of death in women. Women with preeclampsia are three times more likely to develop chronic hypertension and have an elevated risk of future cardiovascular disease. The objective of this article is to provide a review of the factors related to racial and ethnic disparities in blood pressure control. This is followed by a summary of contemporary clinical practice guidelines for the prevention, through lifestyle behavioral modification, and treatment of hypertension with pharmacotherapy.
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Affiliation(s)
- Theresa M Beckie
- College of Nursing and Division of Cardiovascular Sciences, College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612.
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30
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Ghazi L, Dudenbostel T, Hachem ME, Siddiqui M, Lin CP, Oparil S, Calhoun DA. 11-Beta Dehydrogenase Type 2 Activity Is Not Reduced in Treatment Resistant Hypertension. Am J Hypertens 2017; 30:518-523. [PMID: 28180242 DOI: 10.1093/ajh/hpx002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 01/05/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Decreased renal 11-beta dehydrogenase type 2 (11β-HSD2) activity, as reflected by an increased urinary free cortisol to cortisone ratio (UFF/UFE), is associated with having hypertension (HTN). The current study was conducted to determine if reduced 11β-HSD2 activity is also associated with having resistant HTN. METHOD We evaluated 55 consecutive patients with RHTN, defined as blood pressure (BP) ≥140/90 mm Hg despite using ≥3 antihypertensive medications including a diuretic, and 38 patients whose BP was controlled on ≤3 medications to serve as a non-RHTN comparator group. All patients underwent biochemical evaluation, including measurement of 24-hour urinary UFF/UFE. RESULTS The 2 study groups had similar demographic characteristics. Systolic, diastolic BP, and number of antihypertensive medications were greater in patients with uncontrolled RHTN vs. the control group (167.5 ± 28.2/91.2 ± 18.8 vs. 126.6 ± 11.4/77.8 ± 8.65 mm Hg and 4.31 ± 1.23 vs. 2.74 ± 0.6, respectively). The 24-hour UFF was 13.6 ± 11.8 vs. 14.3 ± 10.7 µg/24 h and UFE was 64.9 ± 36.3 vs. 76.1 ± 44 µg/24 h such that the UFF/UFE was 0.22 ± 0.16 vs. 0.19 ± 0.09 in RHTN vs. the control group. This ratio was not associated to age, race, gender, and body mass index. CONCLUSION An elevated UFF/UFE was not present in this large cohort of patients with uncontrolled RHTN. This suggests that reduced conversion of cortisol to cortisone does not contribute to the development of RHTN.
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Affiliation(s)
- Lama Ghazi
- Vascular Biology and Hypertension Program, Cardiovascular Disease, Department of Medicine, University of Birmingham at Alabama, Birmingham, Alabama, USA
| | - Tanja Dudenbostel
- Vascular Biology and Hypertension Program, Cardiovascular Disease, Department of Medicine, University of Birmingham at Alabama, Birmingham, Alabama, USA
| | - Maria El Hachem
- Vascular Biology and Hypertension Program, Cardiovascular Disease, Department of Medicine, University of Birmingham at Alabama, Birmingham, Alabama, USA
| | - Mohammed Siddiqui
- Vascular Biology and Hypertension Program, Cardiovascular Disease, Department of Medicine, University of Birmingham at Alabama, Birmingham, Alabama, USA
| | - Chee Paul Lin
- Center for Clinical and Translational Science, University of Birmingham at Alabama, Birmingham, Alabama, USA
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Cardiovascular Disease, Department of Medicine, University of Birmingham at Alabama, Birmingham, Alabama, USA
| | - David A. Calhoun
- Vascular Biology and Hypertension Program, Cardiovascular Disease, Department of Medicine, University of Birmingham at Alabama, Birmingham, Alabama, USA
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Pilic L, Pedlar CR, Mavrommatis Y. Salt-sensitive hypertension: mechanisms and effects of dietary and other lifestyle factors. Nutr Rev 2016; 74:645-58. [PMID: 27566757 DOI: 10.1093/nutrit/nuw028] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Salt sensitivity, which is an increase in blood pressure in response to high dietary salt intake, is an independent risk factor for cardiovascular disease and mortality. It is associated with physiological, environmental, demographic, and genetic factors. This review focuses on the physiological mechanisms of salt sensitivity in populations at particular risk, along with the associated dietary factors. The interplay of mechanisms such as the renin-angiotensin aldosterone system, endothelial dysfunction, ion transport, and estrogen decrease in women contributes to development of salt sensitivity. Because of their effects on these mechanisms, higher dietary intakes of potassium, calcium, vitamin D, antioxidant vitamins, and proteins rich in L-arginine, as well as adherence to dietary patterns similar to the DASH (Dietary Approaches to Stop Hypertension) diet, can be beneficial to salt-sensitive populations. In contrast, diets similar to the typical Western diet, which is rich in saturated fats, sucrose, and fructose, together with excessive alcohol consumption, may exacerbate salt-sensitive changes in blood pressure. Identifying potential mechanisms of salt sensitivity in susceptible populations and linking them to protective or harmful dietary and lifestyle factors can lead to more specific guidelines for the prevention of hypertension and cardiovascular disease.
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Affiliation(s)
- Leta Pilic
- L. Pilic, C.R. Pedlar, and Y. Mavrommatis are with the School of Sport, Health and Applied Science, St Mary's University, Twickenham, London, United Kingdom. CR Pedlar is with the Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Charles R Pedlar
- L. Pilic, C.R. Pedlar, and Y. Mavrommatis are with the School of Sport, Health and Applied Science, St Mary's University, Twickenham, London, United Kingdom. CR Pedlar is with the Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yiannis Mavrommatis
- L. Pilic, C.R. Pedlar, and Y. Mavrommatis are with the School of Sport, Health and Applied Science, St Mary's University, Twickenham, London, United Kingdom. CR Pedlar is with the Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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Oh YS, Appel LJ, Galis ZS, Hafler DA, He J, Hernandez AL, Joe B, Karumanchi SA, Maric-Bilkan C, Mattson D, Mehta NN, Randolph G, Ryan M, Sandberg K, Titze J, Tolunay E, Toney GM, Harrison DG. National Heart, Lung, and Blood Institute Working Group Report on Salt in Human Health and Sickness: Building on the Current Scientific Evidence. Hypertension 2016; 68:281-8. [PMID: 27324228 DOI: 10.1161/hypertensionaha.116.07415] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Young S Oh
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.).
| | - Lawrence J Appel
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - Zorina S Galis
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - David A Hafler
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - Jiang He
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - Amanda L Hernandez
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - Bina Joe
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - S Ananth Karumanchi
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - Christine Maric-Bilkan
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - David Mattson
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - Nehal N Mehta
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - Gwendolyn Randolph
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - Michael Ryan
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - Kathryn Sandberg
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - Jens Titze
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - Eser Tolunay
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - Glenn M Toney
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
| | - David G Harrison
- From the Division of Cardiovascular Sciences (Y.S.O, Z.S.G., C.M.-B., E.T.) and Division of Intramural Research (N.N.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.); Department of Neurology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT (A.L.H., D.A.H.); Department of Epidemiology, Tulane University, New Orleans, LA (J.H.); Department of Physiology and Pharmacology, University of Toledo, OH (B.J.); Department of Medicine and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.A.K.); Department of Physiology, Medical College of Wisconsin, Milwaukee (D.M.); Department of Pathology and Immunology, Washington University in St. Louis, MO (G.R.); Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (M.R.); Department of Medicine, Georgetown University, Washington, DC (K.S.); Department of Medicine, Vanderbilt University, Nashville, TN (J.T., D.G.H.); and Department of Physiology, University of Texas Health Science Center at San Antonio (G.M.T.)
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Yuan M, Chen W, Teng B, Fang Y. Occupational Disparities in the Association between Self-Reported Salt-Eating Habit and Hypertension in Older Adults in Xiamen, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13010148. [PMID: 26805865 PMCID: PMC4730539 DOI: 10.3390/ijerph13010148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 01/19/2023]
Abstract
Blood pressure responses to sodium intake are heterogeneous among populations. Few studies have assessed occupational disparities in the association between sodium intake and hypertension in older people. We used cross-sectional data from 14,292 participants aged 60 years or older in Xiamen, China, in 2013. Self-reported salt-eating habit was examined with three levels: low, medium, and high. The main lifetime occupation was classified into indoor laborer and outdoor laborer. Multivariable logistic regression was used to examine associations of hypertension with self-reported salt-eating habit, main lifetime occupation, and their interactions by adjusting for some covariates, with further stratification by sex. Overall, 13,738 participants had complete data, of whom 30.22% had hypertension. The prevalence of hypertension was 31.57%, 28.63%, and 31.97% in participants who reported to have low, medium, and high salt-eating habit, respectively. Outdoor laborers presented significantly lower prevalence of hypertension than indoor laborers (26.04% vs. 34.26%, p < 0.001). Indoor laborers with high salt-eating habit had the greatest odds of hypertension (OR = 1.32, 95% CI [1.09–1.59]). An increased trend of odds in eating habit as salt-heavier was presented in indoor laborers (p-trend = 0.048), especially for women (p-trend = 0.001). No clear trend presented in men. Conclusively, sex-specific occupational disparities exist in the association between self-reported salt-eating habit and hypertension in older individuals. Overlooking the potential moderating role of sex and occupation might affect the relationship between sodium intake and hypertension.
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Affiliation(s)
- Manqiong Yuan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an Nan Road, Xiang'an District, Xiamen 361102, Fujian, China.
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiang'an Nan Road, Xiang'an District, Xiamen 361102, Fujian, China.
| | - Wei Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an Nan Road, Xiang'an District, Xiamen 361102, Fujian, China.
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiang'an Nan Road, Xiang'an District, Xiamen 361102, Fujian, China.
| | - Bogang Teng
- School of Public Health, Xiamen University, Xiang'an Nan Road, Xiang'an District, Xiamen 361102, Fujian, China.
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an Nan Road, Xiang'an District, Xiamen 361102, Fujian, China.
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiang'an Nan Road, Xiang'an District, Xiamen 361102, Fujian, China.
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The influence of high versus low sodium intake on blood pressure and haemodynamics in patients with morbid obesity. J Hypertens 2015; 31:2220-9; discussion 2229. [PMID: 23868085 DOI: 10.1097/hjh.0b013e328363c769] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Many patients with morbid obesity (BMI > 40 kg/m) have hypertension. The complex pathophysiological abnormalities linking hypertension to obesity have not been fully clarified, but abnormal sodium handling could be an important mechanism. METHOD Therefore, we examined changes in body fluid compartments and haemodynamic responses (at rest and during exercise) after 5 days of a low-sodium diet (90 mmol/day) and 5 days of a high-sodium diet (250 mmol/day) in 12 morbidly obese, hypertensive patients; 12 morbidly obese, normotensive patients and 12 nonobese controls. RESULTS High sodium intake as compared to low sodium intake was associated with an increase in plasma volume (obese, hypertensive patients: 5 ± 4%; obese, normotensive patients: 10 ± 11%; nonobese controls: 7 ± 6%), cardiac output (CO) (obese, hypertensive patients: 17 ± 12%; obese, normotensive patients: 20 ± 16%; nonobese controls: 13 ± 14%) and stroke volume (SV) (obese, hypertensive patients: 27 ± 26%; obese, normotensive patients: 27 ± 24%; nonobese controls: 18 ± 27%) in all three groups with no differences between the groups. Despite an increase in CO during high salt intake, 24-h blood pressure (BP) was unchanged in patients and controls as a result of a reduction in total peripheral resistance (obese, hypertensive patients: -11 ± 11%; obese, normotensive patients: -10 ± 12%; nonobese controls: -5 ± 14%). Similar changes were observed during an incremental bicycle exercise test wherein CO and SV were higher, whereas mean arterial BP was unchanged at each exercise level during high sodium intake. CONCLUSION Despite substantial increases in CO and SV, we did not observe any significant change in BP during high sodium intake, neither in morbid obese patients nor in lean individuals.
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Chen G, de las Fuentes L, Gu CC, He J, Gu D, Kelly T, Hixson J, Jacquish C, Rao DC, Rice TK. Aggregate blood pressure responses to serial dietary sodium and potassium intervention: defining responses using independent component analysis. BMC Genet 2015; 16:64. [PMID: 26088064 PMCID: PMC4474450 DOI: 10.1186/s12863-015-0226-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 06/10/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hypertension is a complex trait that often co-occurs with other conditions such as obesity and is affected by genetic and environmental factors. Aggregate indices such as principal components among these variables and their responses to environmental interventions may represent novel information that is potentially useful for genetic studies. RESULTS In this study of families participating in the Genetic Epidemiology Network of Salt Sensitivity (GenSalt) Study, blood pressure (BP) responses to dietary sodium interventions are explored. Independent component analysis (ICA) was applied to 20 variables indexing obesity and BP measured at baseline and during low sodium, high sodium and high sodium plus potassium dietary intervention periods. A "heat map" protocol that classifies subjects based on risk for hypertension is used to interpret the extracted components. ICA and heat map suggest four components best describe the data: (1) systolic hypertension, (2) general hypertension, (3) response to sodium intervention and (4) obesity. The largest heritabilities are for the systolic (64%) and general hypertension (56%) components. There is a pattern of higher heritability for the component response to intervention (40-42%) as compared to those for the traditional intervention responses computed as delta scores (24%-40%). CONCLUSIONS In summary, the present study provides intermediate phenotypes that are heritable. Using these derived components may prove useful in gene discovery applications.
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Affiliation(s)
- Gengsheng Chen
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | | | - Chi C Gu
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | - Jiang He
- Tulane University Health Sciences Center, New Orleans, LA, USA.
| | - Dongfeng Gu
- Chinese Academy of Medical Sciences, Beijing, China.
| | - Tanika Kelly
- Tulane University Health Sciences Center, New Orleans, LA, USA.
| | - James Hixson
- University of Texas Health Sciences Center at Houston, Houston, TX, USA.
| | | | - D C Rao
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | - Treva K Rice
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
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Wang Y, Mu JJ, Geng LK, Wang D, Ren KY, Guo TS, Chu C, Xie BQ, Liu FQ, Yuan ZY. Effect of salt intake and potassium supplementation on brachial-ankle pulse wave velocity in Chinese subjects: an interventional study. ACTA ACUST UNITED AC 2014; 48:83-90. [PMID: 25493387 PMCID: PMC4288497 DOI: 10.1590/1414-431x20144213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 09/22/2014] [Indexed: 01/11/2023]
Abstract
Accumulating evidence has suggested that high salt and potassium might be associated
with vascular function. The aim of this study was to investigate the effect of salt
intake and potassium supplementation on brachial-ankle pulse wave velocity (PWV) in
Chinese subjects. Forty-nine subjects (28-65 years of age) were selected from a rural
community of northern China. All subjects were sequentially maintained on a low-salt
diet for 7 days (3.0 g/day NaCl), a high-salt diet for an additional 7 days (18.0
g/day NaCl), and a high-salt diet with potassium supplementation for a final 7 days
(18.0 g/day NaCl+4.5 g/day KCl). Brachial-ankle PWV was measured at baseline and on
the last day of each intervention. Blood pressure levels were significantly increased
from the low-salt to high-salt diet, and decreased from the high-salt diet to
high-salt plus potassium supplementation. Baseline brachial-ankle PWV in
salt-sensitive subjects was significantly higher than in salt-resistant subjects.
There was no significant change in brachial-ankle PWV among the 3 intervention
periods in salt-sensitive, salt-resistant, or total subjects. No significant
correlations were found between brachial-ankle PWV and 24-h sodium and potassium
excretions. Our study indicates that dietary salt intake and potassium
supplementation, at least in the short term, had no significant effect on
brachial-ankle PWV in Chinese subjects.
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Affiliation(s)
- Y Wang
- Cardiovascular Department, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, P. R., China
| | - J J Mu
- Cardiovascular Department, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, P. R., China
| | - L K Geng
- Cardiovascular Department, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, P. R., China
| | - D Wang
- Cardiovascular Department, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, P. R., China
| | - K Y Ren
- Cardiovascular Department, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, P. R., China
| | - T S Guo
- Cardiovascular Department, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, P. R., China
| | - C Chu
- Cardiovascular Department, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, P. R., China
| | - B Q Xie
- Cardiovascular Department, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, P. R., China
| | - F Q Liu
- Cardiovascular Department, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, P. R., China
| | - Z Y Yuan
- Cardiovascular Department, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, P. R., China
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Abstract
The racial disparity in hypertension and hypertension-related outcomes has been recognized for decades with African Americans with greater risks than Caucasians. Blood pressure levels have consistently been higher for African Americans with an earlier onset of hypertension. Although awareness and treatment levels of high blood pressure have been similar, racial differences in control rates are evident. The higher blood pressure levels for African Americans are associated with higher rates of stroke, end-stage renal disease and congestive heart failure. The reasons for the racial disparities in elevated blood pressure and hypertension-related outcomes risk remain unclear. However, the implications of the disparities of hypertension for prevention and clinical management are substantial, identifying African American men and women with excel hypertension risk and warranting interventions focused on these differences. In addition, focused research to identify the factors attributed to these disparities in risk burden is an essential need to address the evidence gaps.
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Affiliation(s)
- Daniel T. Lackland
- Department of Neurosciences Harborview Office Tower, Suite 501 Medical University of South Carolina Charleston SC 29425
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Cuyjet AB, Akinboboye O. Acute heart failure in the African American patient. J Card Fail 2014; 20:533-40. [PMID: 24814871 DOI: 10.1016/j.cardfail.2014.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/07/2014] [Accepted: 04/28/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND African Americans (AAs) are disproportionately affected by acute heart failure (AHF) compared with other racial/ethnic groups. Disparities in AHF risk factors among AAs are attributed to higher rates of hypertension and diabetes mellitus, lower socioeconomic status, higher dietary caloric and salt intake, and biologic/genetic differences. However, AAs are frequently underrepresented in AHF clinical trials, and race-related differences in risks and clinical outcomes are not well understood. OBJECTIVE The aim of this work was to review published data on AHF in the AA population, including management strategies that may differ based on race and common barriers to optimal care. METHODS Publications were identified in Pubmed (through June 10, 2013) with the use of the search strategy terms (acute heart failure) AND (black OR African American OR racial). RESULTS Racial disparities in the quality of AHF care are relatively uncommon; however, racial differences in pathophysiology have resulted in differing pharmacologic recommendations (eg, isosorbide dinitrate plus hydralazine is indicated only in AAs). Various socioeconomic factors influence disease progression, treatment compliance, and hospitalization/rehospitalization rates. CONCLUSIONS Further research would enhance understanding of pathophysiologic heart failure differences between racial groups. Programs are needed that incorporate known clinical and cultural differences to improve quality of care and reduce the disease burden of AHF for all patients.
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Affiliation(s)
| | - Ola Akinboboye
- Association of Black Cardiologists, Washington DC Heart House, Washington, DC; Weill Medical College of Cornell University, New York, New York; Laurelton Heart Specialists P.C., Rosedale, New York
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Dwivedi G, Beevers DG. Hypertension in ethnic groups: epidemiological and clinical perspectives. Expert Rev Cardiovasc Ther 2014; 7:955-63. [DOI: 10.1586/erc.09.88] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Millen AME, Norton GR, Majane OHI, Maseko MJ, Brooksbank R, Michel FS, Snyman T, Sareli P, Woodiwiss AJ. Insulin resistance and the relationship between urinary Na(+)/K(+) and ambulatory blood pressure in a community of African ancestry. Am J Hypertens 2013; 26:708-16. [PMID: 23547038 DOI: 10.1093/ajh/hpt010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although groups of African descent are particularly sensitive to blood pressure (BP) effects of salt intake, the role of obesity and insulin resistance in mediating this effect is uncertain. We determined whether obesity or insulin resistance is independently associated with urinary Na(+)/K(+)-BP relationships in a community sample of African ancestry. METHODS We measured 24-hour urinary Na(+)/K(+), homeostasis model assessment of insulin resistance (HOMA-IR), and nurse-derived conventional and 24-hour ambulatory BP in 331 participants from a South African community sample of black African descent not receiving treatment for hypertension. RESULTS With adjustments for diabetes mellitus and the individual terms, an interaction between waist circumference and urinary Na(+)/K(+) was associated with day diastolic BP (P < 0.05) and an interaction between log HOMA-IR and urinary Na(+)/K(+) was associated with 24-hour and day systolic (P < 0.05) and 24-hour, day, and night diastolic (P < 0.002; P < 0.001) BP. The multivariable-adjusted relationship between urinary Na(+)/K(+) and night diastolic BP increased across tertiles of HOMA-IR (tertile 1: β-coefficient = -0.79 ± 0.47; tertile 2: β-coefficient = 0.65 ± 0.35; tertile 3: β-coefficient = 1.03 ± 0.46; P < 0.05 tertiles 3 and 2 vs. 1). The partial correlation coefficients for relationships between urinary Na(+)/K(+) and 24-hour (partial r = 0.19; P < 0.02), day (partial r = 0.17; P < 0.05), and night (partial r = 0.18; P < 0.02) diastolic BP in participants with log HOMA-IR greater than or equal to the median were greater than those for relationships between urinary Na(+)/K(+) and 24-hour (partial r = -0.08; P = 0.29), day (partial r = -0.10; P < 0.22), and night (partial r = -0.06; P = 0.40) diastolic BP in participants with log HOMA-IR less than the median (comparisons of r values: P < 0.05). CONCLUSIONS Insulin resistance may modify the relationship between salt intake, indexed by urinary Na(+)/K(+), and ambulatory BP in groups of African descent.
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Affiliation(s)
- Aletta M E Millen
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Richardson SI, Freedman BI, Ellison DH, Rodriguez CJ. Salt sensitivity: a review with a focus on non-Hispanic blacks and Hispanics. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2013; 7:170-9. [PMID: 23428408 PMCID: PMC4574876 DOI: 10.1016/j.jash.2013.01.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/08/2013] [Accepted: 01/11/2013] [Indexed: 01/07/2023]
Abstract
The purpose of this review is to summarize the available information regarding salt sensitivity particularly as it relates to non-Hispanic blacks and Hispanics and to clarify possible etiologies, especially those that might shed light on potential treatment options. In non-Hispanic blacks, there is evidence that endothelial dysfunction, reduced potassium intake, decreased urinary kallikrein excretion, upregulation of sodium channel activity, dysfunction in atrial natriuretic peptide (ANP) production, and APOL1 gene nephropathy risk variants may cause or contribute to salt sensitivity. Supported treatment avenues include diets high in potassium and soybean protein, the components of which stimulate nitric oxide production. Racial heterogeneity complicates the study of salt sensitivity in Hispanic populations. Caribbean Hispanics, who have a higher proportion of African ancestry, may respond to commonly prescribed anti-hypertensive agents in a way that is characteristic of non-Hispanic black hypertensives. The low-renin hypertensive phenotype commonly seen in non-Hispanic blacks has been linked to salt sensitivity and may indicate an increased risk for salt sensitivity in a portion of the Hispanic population. In conclusion, increased morbidity and mortality associated with salt sensitivity mandates further studies evaluating the efficacy of tailored dietary and pharmacologic treatment in non-Hispanic blacks and determining the prevalence of low renin hypertension and salt sensitivity within the various subgroups of Hispanic Americans.
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Affiliation(s)
| | - Barry I. Freedman
- Department of Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David H. Ellison
- Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, OR, USA
| | - Carlos J. Rodriguez
- Department of Medicine and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Yaméogo NV, Kagambèga LJ, Millogo RCG, Kologo KJ, Yaméogo AA, Mandi GD, Ilboudo E, Toguyeni BJY, Samadoulougou AK, Zabsonré P. [Factors associated with poor blood pressure control in hypertensive black Africans: cross-sectional study of 456 hypertensive patients from Burkina Faso]. Ann Cardiol Angeiol (Paris) 2013; 62:38-42. [PMID: 22677180 DOI: 10.1016/j.ancard.2012.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 05/02/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Hypertension in black is more frequent with early onset and clinically more severe. The blood pressure control and the decrease of global cardiovascular risk are two main goals of the treatment of hypertension. The objectives of this study were to determine the proportion of uncontrolled hypertension in hypertensive patients followed as outpatients and to investigate the factors associated with poor control. PATIENTS AND METHODS This is a descriptive cross-sectional study including 456 hypertensive patients known and followed as outpatients. Blood pressure measurement was performed between 8 am and 12 noon both arms in the supine position, after a compliance averaging 8 minutes of rest. We searched for conventional cardiovascular risk factors (age superior or equal to 45 years for men and superior or equal to 55 for women, physical inactivity, overweight/obesity, smoking, diabetes and dyslipidemia) and calculated the global cardiovascular risk according to the Framingham model. Was regarded as uncontrolled high blood pressure SBP superior or equal to 140 mmHg and/or DBP superior or equal to 90 mmHg. Univariate analysis and multivariate logistic regression (using SPSS program version 17) were conducted to look for factors associated with poor blood pressure control. RESULTS We recruited 456 hypertensive patients including 259 women (56.8%). Modifiable cardiovascular risk factors also hypertension were dominated by dyslipidemia (29.8%) and diabetes (24.6%). The global cardiovascular risk calculated using the Framingham model was low in 21.3%, moderate in 34.0%, high in 24.8% and very high in 19.9% of cases. The proportion of uncontrolled hypertension was 54.2% (n=247 including 126 women and 121 men). This poor blood pressure control was associated (multivariate analysis) at age superior or equal to 60 years, low socioeconomic status, high to very high cardiovascular risk, antihypertensive monotherapy, treatment duration superior or equal to 10 years, an associated treatment and non-compliance therapy. CONCLUSION More than half of hypertensive patients in our study were not adequately controlled on antihypertensive therapy. Factors of poor control were age superior or equal to 60 years, low socioeconomic status, high to very high cardiovascular risk, antihypertensive monotherapy, treatment duration superior or equal to 10 years, an associated treatment and non-compliance therapy.
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Affiliation(s)
- N V Yaméogo
- Service de cardiologie, CHU Yalgado Ouedraogo, 03 BP, 7022 Ouagadougou, Burkina Faso.
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Kelly TN, Rebholz CM, Gu D, Hixson JE, Rice TK, Cao J, Chen J, Li J, Lu F, Ma J, Mu J, Whelton PK, He J. Analysis of sex hormone genes reveals gender differences in the genetic etiology of blood pressure salt sensitivity: the GenSalt study. Am J Hypertens 2013; 26:191-200. [PMID: 23382403 DOI: 10.1093/ajh/hps018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We examined the association between 799 single-nucleotide polymorphisms in 39 sex hormone genes and blood pressure (BP) responses to a dietary-sodium intervention. METHODS A 7-day low-sodium feeding study (51.3 mmol sodium/day) followed by a 7-day high-sodium feeding study (307.8 mmol sodium/day) was conducted among 1,906 Han Chinese participants. Nine BP measurements were obtained at baseline and the end of each intervention period using a random-zero sphygmomanometer. RESULTS Among men, absolute BP responses to sodium interventions decreased with the number of minor alleles of estrogen receptor 1 (ESR1) markers rs9340844, rs9397453, rs9371562, rs9397459, and rs9383951. For example, mean diastolic blood pressure (DBP) responses to low-sodium intervention (95% confidence interval) were -2.67 (-3.13, -2.22) mm Hg among those with the rs9397453 C/C genotype, -1.23 (-1.98, -0.48) mm Hg among those with the C/T genotype, and 0.08 (-2.31, 2.47) mm Hg among those with the T/T genotype (P = 1×10(-4); false discovery rate (FDR)-q = 0.04). Mean DBP responses to high sodium according to the rs9397453 genotypes were 1.46 (1.03, 1.89) mm Hg among those with C/C, 0.19 (-0.54, 0.91) mm Hg among those with C/T, and -1.10 (-2.82, 0.61) mm Hg among those with T/T (P = 2×10(-4); FDR-q = 0.04). Similar trends were noted for the association between these ESR1 variants and SBP responses to the dietary intervention. There were no significant associations between sex hormone gene variants and salt sensitivity in women, with genotype-gender interactions noted for the ESR1 markers that achieved significance in men. CONCLUSIONS We identified strong, consistent associations between ESR1 gene variants and salt sensitivity in men. Our results support a gender-specific role for ESR1 in the etiology of this complex trait.
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Affiliation(s)
- Tanika N Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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Abstract
Mammalian cells tightly regulate cellular Mg(2+) content through a variety of transport and buffering mechanisms under the control of various hormones and cellular second messengers. The effect of these hormones and agents results in dynamic changes in the total content of Mg(2+) being transported across the cell membrane and redistributed within cellular compartments. The importance of maintaining proper cellular Mg(2+) content optimal for the activity of various cellular enzymes and metabolic cycles is underscored by the evidence that several diseases are characterized by a loss of Mg(2+) within specific tissues as a result of defective transport, hormonal stimulation, or metabolic impairment. This chapter will review the key mechanisms regulating cellular Mg(2+) homeostasis and their impairments under the most common diseases associated with Mg(2+) loss or deficiency.
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Affiliation(s)
- Andrea M P Romani
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4970, USA,
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Biologic Measures as Epidemiological Indicators of Risk for the Development of Hypertension in an African American Adolescent Population. J Cardiovasc Nurs 2012; 27:476-84. [DOI: 10.1097/jcn.0b013e31822f7971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ferdinand KC, Weitzman R, Purkayastha D, Sridharan K, Jaimes EA. Aliskiren-based dual- and triple-combination therapies in high-risk US minority patients with Stage 2 hypertension. ACTA ACUST UNITED AC 2012; 6:219-27. [PMID: 22305998 DOI: 10.1016/j.jash.2011.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 12/01/2011] [Accepted: 12/20/2011] [Indexed: 01/13/2023]
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Liu F, Mu J, Yuan Z, Lian Q, Zheng S, Wu G, Liu E. Involvement of the lymphatic system in salt-sensitive hypertension in humans. Med Sci Monit 2012; 17:CR542-6. [PMID: 21959606 PMCID: PMC3539464 DOI: 10.12659/msm.881978] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background The mechanisms of salt sensitivity as an important intermediate phenotype of essential hypertension remain elusive. A novel theory proposes that lymphatic vessels regulate sodium and fluid homeostasis. Since vascular endothelial growth factor C (VEGF-C) plays a vital role in lymphatic capillary hyperplasia, we hypothesized that VEGF-C was involved in salt-sensitive hypertension. We therefore investigated its plasma concentration in salt-sensitive subjects. Material/Methods Twenty-seven subjects (BP ≤160/100 mmHg; age range 25–50 years) from a rural community of northern China were enrolled in this study. The baseline BP of volunteers was monitored for 3 days, followed by a low-salt diet for 7 days (3 g/day, NaCl) and a high-salt diet for 7 days (18 g/day, NaCl). Those who exhibited a BP increase of 10% from low-salt period to high-salt period were diagnosed as salt-sensitive subjects. The concentration of plasma VEGF-C was measured by an immunoenzyme method (ELISA). Result High salt intake significantly increased the plasma VEGF-C level. It was higher in the salt-sensitive subjects (3642.2±406.1 pg/ml) than in the salt-resistant subjects (2249.8±214.6 pg/ml). The comparison of VEGF-C levels between the 2 groups had significant statistical difference (P<0.01). Conclusions The VEGF-C level increases significantly in the salt-sensitive subjects after high salt intake. VEGF-C could be used as a biomarker of salt sensitivity.
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Affiliation(s)
- Fuqiang Liu
- Cardiovascular Department, 1st Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, PR China
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Liu F, Mu J, Yuan Z, Wu G, Liu E, Zheng S, Lian Q, Ren K, Xu H. High salt intake fails to enhance plasma adiponectin in normotensive salt-sensitive subjects. Nutrition 2011; 28:422-5. [PMID: 22189196 DOI: 10.1016/j.nut.2011.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 08/21/2011] [Accepted: 08/21/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evidence shows that salt can modulate adiponectin and inflammation levels in normal individuals. Therefore, we hypothesized that abnormalities in adiponectin and inflammation might be the potential mechanism of salt sensitivity. The aim of this study was to investigate whether different alterations of adiponectin and inflammation levels in response to a high-salt intake were exhibited between normotensive salt-sensitive and salt-resistant subjects. METHODS Thirty normotensive subjects (25 to 50 y old) were selected from a rural community of northern China. They were sequentially maintained on a normal diet for 3 d at baseline, a low-salt diet for 7 d (NaCl 3 g/d), and then a high-salt diet for 7 d (18 g/d). RESULTS Salt sensitivity was diagnosed in 10 subjects who exhibited an increase of at least 10% in mean blood pressure from the low-salt to the high-salt periods. Plasma adiponectin was significantly higher with the high-salt intake than with the low-salt intake (6.1 ± 1.3 versus 7.1 ± 1.7 μg/mL, P = 0.047) in normotensive salt-resistant subjects but not in the normotensive salt-sensitive subjects (6.4 ± 2 versus 5.9 ± 2.1 μg/mL, P = 0.481). The high-salt intake markedly increased plasma tumor necrosis factor-α (P < 0.0001) and monocyte chemoattractant protein-1 (P < 0.0001) in normotensive salt-sensitive and salt-resistant subjects. No significant change in plasma high-sensitivity C-reactive protein was observed. CONCLUSIONS Our data indicate that the disturbance of adiponectin exists in normotensive salt-sensitive subjects during a high-salt diet, which may be a novel underlying mechanism of salt sensitivity.
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Affiliation(s)
- Fuqiang Liu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Peoples Republic of China
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Abstract
Clinical trials have demonstrated that a reduced intake of dietary sodium lowers blood pressure. However, blood pressure reduction in response to a decrease in dietary sodium intake varies considerably among different individuals-a phenomenon described as sodium sensitivity. The Genetic Epidemiology Network of Salt Sensitivity (GenSalt) study was a large family-based dietary-feeding study conducted in rural north China. This study indicated that approximately 39% of Chinese adults were sodium-sensitive. Sodium sensitivity was more common in women and in persons who were older and had higher usual blood pressure. Sodium sensitivity was also more common in individuals with higher responses to a cold pressor test and in individuals with the metabolic syndrome. Genetic factors may play an important role in determining sodium sensitivity in the Chinese population. A better understanding of the genetic and environmental determinants of sodium sensitivity has important public health and clinical implications.
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Izzo JL, Zion AS. Combined aliskiren-amlodipine treatment for hypertension in African Americans: clinical science and management issues. Ther Adv Cardiovasc Dis 2011; 5:169-78. [PMID: 21606125 DOI: 10.1177/1753944711409615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
While it may seem at first that antihypertensive drug combinations run counter to the desire to 'personalize' the management of hypertension, the best combinations have predictable efficacy in different individuals and subpopulations. Race is probably not a valid surrogate for clinically meaningful genetic variation or guide to therapy. Most guidelines suggest similar blood pressure goals for different races but drug treatment recommendations have diverged. In the United States, race is not considered to be a major factor in drug choice, but in England and other countries, initial therapy with renin-angiotensin system blocking drugs is not recommended in Blacks. In this review we: (1) examine new trends in race-based research; (2) emphasize the weaknesses of race-based treatment recommendations; and (3) explore the effects of a new combination, renin inhibition (aliskiren) and amlodipine, in African Americans.
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Affiliation(s)
- Joseph L Izzo
- Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 462 Grider Street, Buffalo, NY 14215, USA.
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