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Duan S, Ma Y, Lu F, Zhang C, Guo H, Zeng M, Sun B, Yuan Y, Xing C, Mao H, Zhang B. High sodium intake and fluid overhydration predict cardiac structural and functional impairments in chronic kidney disease. Front Nutr 2024; 11:1388591. [PMID: 38860161 PMCID: PMC11164051 DOI: 10.3389/fnut.2024.1388591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/14/2024] [Indexed: 06/12/2024] Open
Abstract
Background High sodium intake and fluid overhydration are common factors of and strongly associated with adverse outcomes in chronic kidney disease (CKD) patients. Yet, their effects on cardiac dysfunction remain unclear. Aims The study aimed to explore the impact of salt and volume overload on cardiac alterations in non-dialysis CKD. Methods In all, 409 patients with CKD stages 1-4 (G1-G4) were enrolled. Daily salt intake (DSI) was estimated by 24-h urinary sodium excretion. Volume status was evaluated by the ratio of extracellular water (ECW) to total body water (TBW) measured by body composition monitor. Recruited patients were categorized into four groups according to DSI (6 g/day) and median ECW/TBW (0.439). Echocardiographic and body composition parameters and clinical indicators were compared. Associations between echocardiographic findings and basic characteristics were performed by Spearman's correlations. Univariate and multivariate binary logistic regression analysis were used to determine the associations between DSI and ECW/TBW in the study groups and the incidence of left ventricular hypertrophy (LVH) and elevated left ventricular filling pressure (ELVFP). In addition, the subgroup effects of DSI and ECW/TBW on cardiac abnormalities were estimated using Cox regression. Results Of the enrolled patients with CKD, the median urinary protein was 0.94 (0.28-3.14) g/d and estimated glomerular filtration rate (eGFR) was 92.05 (IQR: 64.52-110.99) mL/min/1.73 m2. The distributions of CKD stages G1-G4 in the four groups was significantly different (p = 0.020). Furthermore, compared to group 1 (low DSI and low ECW/TBW), group 4 (high DSI and high ECW/TBW) showed a 2.396-fold (95%CI: 1.171-4.902; p = 0.017) excess risk of LVH and/or ELVFP incidence after adjusting for important CKD and cardiovascular disease risk factors. Moreover, combined with eGFR, DSI and ECW/TBW could identify patients with higher cardiac dysfunction risk estimates with an AUC of 0.704 (sensitivity: 75.2%, specificity: 61.0%). The specificity increased to 85.7% in those with nephrotic proteinuria (AUC = 0.713). The magnitude of these associations was consistent across subgroups analyses. Conclusion The combination of high DSI (>6 g/d) and high ECW/TBW (>0.439) independently predicted a greater risk of LVH or ELVFP incidence in non-dialysis CKD patients. Moreover, the inclusion of eGFR and proteinuria improved the risk stratification ability of DSI and ECW/TBW in cardiac impairments in CKD.
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D’Elia L, Strazzullo P. Dietary Salt Restriction and Adherence to the Mediterranean Diet: A Single Way to Reduce Cardiovascular Risk? J Clin Med 2024; 13:486. [PMID: 38256620 PMCID: PMC10816989 DOI: 10.3390/jcm13020486] [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: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
The dietary restriction of salt intake and the adhesion to Mediterranean dietary patterns are among the most recommended lifestyle modifications for the prevention of cardiovascular diseases. A large amount of evidence supports these recommendations; indeed, several studies show that a higher adherence to Mediterranean dietary patterns is associated with a reduced risk of cardiovascular disease. Likewise, findings from observational and clinical studies suggest a causal role of excess salt intake in blood pressure increase, cardiovascular organ damage, and the incidence of cardiovascular diseases. In this context, it is also conceivable that the beneficial effects of these two dietary patterns overlap because Mediterranean dietary patterns are typically characterized by a large consumption of plant-based foods with low sodium content. However, there is little data on this issue, and heterogeneous results are available on the relationship between adherence to salt restriction and to Mediterranean dietary patterns. Thus, this short review focuses on the epidemiological and clinical evidence of the relationship between the adherence to Mediterranean dietary patterns and dietary salt restriction in the context of cardiovascular risk.
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Affiliation(s)
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy;
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Peprah E, Amegbor P, Laar A, Akasoe B, Commodore-Mensah Y. Reducing Dietary Sodium Intake among Young Adults in Ghana: A Call to Action. Nutrients 2023; 15:3562. [PMID: 37630752 PMCID: PMC10458370 DOI: 10.3390/nu15163562] [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: 07/10/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
The positive association between excessive dietary sodium intake, hypertension, and cardiovascular disease (CVD) has been widely investigated in observational studies and clinical trials. Reducing sodium intake is a proven strategy to prevent hypertension and the onset of CVD, a major cause of morbidity and mortality globally. Africa has the youngest population globally, which is key to the continent's sustainable development. However, in Africa, the epidemics of hypertension and CVD negatively impact life expectancy and economic growth. Ghana, like other African countries, is no exception. The factors contributing to the increasing burden of CVD and excessive sodium consumption are multi-faceted and multi-level, including individual lifestyle, neighborhood and built environments, and socio-economic and health policies. Thus, the implementation of evidence-based interventions such as the World Health Organization Best Buys that target the multi-level determinants of sodium consumption is urgently needed in Ghana and other African countries. The aim of this commentary is to highlight factors that contribute to excessive sodium consumption. Second, the commentary will showcase lessons of successful implementation of sodium reduction interventions in other countries. Such lessons may help avert CVD in young adults in Ghana and Africa.
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Affiliation(s)
- Emmanuel Peprah
- Department of Global and Environmental Health, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA;
| | - Prince Amegbor
- Department of Global and Environmental Health, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA;
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra P.O. Box LG13, Ghana; (A.L.); (B.A.)
| | - Bismark Akasoe
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra P.O. Box LG13, Ghana; (A.L.); (B.A.)
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Abstract
Isolated systolic hypertension is associated with higher risk of cardiovascular disease and all-cause mortality. Despite being the most common form of hypertension in the elderly, it is also detectable among young and middle-aged subjects. Dietary salt (sodium chloride) intake is an important determinant of blood pressure, and high salt intake is associated with greater risk of hypertension and cardiovascular events. In most countries, habitual salt intake at all age categories largely exceeds the international recommendations. Excess salt intake, often interacting with overweight and insulin resistance, may contribute to the development and maintenance of isolated systolic hypertension in young individuals by causing endothelial dysfunction and promoting arterial stiffness through a number of mechanisms, namely increase in the renin-angiotensin-aldosterone system activity, sympathetic tone and salt-sensitivity. This short review focused on the epidemiological and clinical evidence, the mechanistic pathways and the cluster of pathophysiological factors whereby excess salt intake may favor the development and maintenance of isolated systolic hypertension in young people.
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Affiliation(s)
- Lanfranco D'Elia
- Medical School, Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, University of Naples Federico II, Naples, Italy
| | - Pasquale Strazzullo
- Medical School, Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, University of Naples Federico II, Naples, Italy -
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Shuvo SD, Zahid MA, Rahman MM, Parvin R. Exploring the impact of soil and water salinity on dietary behavior and health risk of coastal communities in Bangladesh. JOURNAL OF WATER AND HEALTH 2020; 18:1110-1123. [PMID: 33328380 DOI: 10.2166/wh.2020.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to evaluate the impact of soil and water salinity on dietary behavior and health risk in the coastal people of Bangladesh. This study was conducted among 240 respondents in rural coastal sub-districts in Khulna and Patuakhali of Bangladesh using a simple random sampling technique. To evaluate the association between health risk and salinity exposure categories, a multinomial logit regression analysis was conducted and statistical significance was declared at p ≤ 0.05. A significantly higher amount of salinity (NaCl) level was found in radish, potato, bean, bitter gourd, rice, shallow tube-well, and pond water from Patuakhali than Khulna. Males and those aged 36-50 years (RRR:1.89, SE:0.58) and 51-65 years (RRR:4.51, SE:1.81) were associated with hypertension compared with the females (RRR:0.57, SE:0.18) and age group 20-35 years. Consumption of shallow tube-well water (RRR:3.12, SE:1.46), salt content rice (RRR:1.36, SE:0.50), salt content vegetables (RRR:1.09, SE:0.09), salt content fish (RRR:2.77, SE:0.47), and intake of table salt (RRR:1.05, SE:0.03) were significantly associated with risk factors of hypertension (p < 0.01). A sustainable policy for salt reduction through dietary interventions along with the promotion of low saline foods and drinking water must be a priority with special emphasis on coastal areas.
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Affiliation(s)
- Suvasish Das Shuvo
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh E-mail:
| | - Md Ashrafuzzaman Zahid
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh E-mail:
| | - Mohammad Mahfuzur Rahman
- Department of Environmental Science and Technology, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Rashida Parvin
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh E-mail:
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Almeida V, Seto T, Banna J. Considerations for Measurement of Sodium Intake. Am J Lifestyle Med 2020; 14:585-588. [PMID: 33117098 DOI: 10.1177/1559827620946737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Current salt consumption is the major risk factor for hypertension and consequently cardiovascular disease (CVD). Accurate measurement of Na intake is an important component of developing dietary interventions to treat hypertension and lower CVD risk. Given that existing methods have a large subject burden, quick and practical ways to assess Na intake in individuals, particularly in hypertensive subjects, are needed. Such tools may be used for motivation to quantify salt intake and to set targets for lifestyle changes for prevention of CVD within a clinic setting. Patients at high risk of development of CVD may be identified and targeted for motivational interviewing. They may also be used as part of cardiac rehabilitation programs and will allow individuals to measure their own intake and to see the results of their individual action.
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Affiliation(s)
- Vanessa Almeida
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Todd Seto
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, Hawaii
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D'Elia L, La Fata E, Giaquinto A, Strazzullo P, Galletti F. Effect of dietary salt restriction on central blood pressure: A systematic review and meta-analysis of the intervention studies. J Clin Hypertens (Greenwich) 2020; 22:814-825. [PMID: 32271997 DOI: 10.1111/jch.13852] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 01/11/2023]
Abstract
Central blood pressure (cBP) is highly associated with cardiovascular risk. Although reduction of salt intake leads to lower peripheral blood pressure (BP), the studies on cBP provided inconsistent results. Therefore, we performed a systematic review and a meta-analysis of the available intervention trials of salt reduction on cBP values to reach definitive conclusions. A systematic search of the online databases available (up to December 2018) was conducted including the intervention trials that reported non-invasively assessed cBP changes after two different salt intake regimens. For each study, the mean difference and 95% confidence intervals were pooled using a random-effect model. Sensitivity, heterogeneity, publication bias, subgroup, and meta-regression analyses were performed. Fourteen studies met the pre-defined inclusion criteria and provided 17 cohorts with 457 participants with 1-13 weeks of intervention time. In the pooled analysis, salt restriction was associated with a significant reduction in augmentation index (9.3%) as well as central systolic BP and central pulse pressure. There was a significant heterogeneity among studies (I2 = 70%), but no evidence of publication bias. Peripheral BP changes seemed to partially interfere on the relationship between salt restriction and cBP. The results of this meta-analysis indicate that dietary salt restriction reduces cBP. This effect seems to be, at least in part, independent of the changes in peripheral BP.
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Affiliation(s)
- Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, Federico II, University of Naples Medical School, Naples, Italy
| | | | - Alfonso Giaquinto
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, Federico II, University of Naples Medical School, Naples, Italy
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, Federico II, University of Naples Medical School, Naples, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, Federico II, University of Naples Medical School, Naples, Italy
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Kannenkeril D, Karg MV, Bosch A, Ott C, Linz P, Nagel AM, Uder M, Schmieder RE. Tissue sodium content in patients with type 2 diabetes mellitus. J Diabetes Complications 2019; 33:485-489. [PMID: 31101486 DOI: 10.1016/j.jdiacomp.2019.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/15/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Tissue sodium content by 23Na magnetic resonance imaging (MRI) has been found to be increased in arterial hypertension. We analyzed whether tissue sodium content is increased in patients with type-2 diabetes (T2DM). METHODS Patients with T2DM were compared to those with primary hypertension. Patients with T2DM were off any antidiabetic and hypertensive patients off any antihypertensive therapy for at least 4 weeks. Skin and muscle sodium content was assessed non-invasively with a 3.0 T clinical MRI system (Magnetom Verio, Siemens Health Care, Erlangen, Germany) in each patient. RESULTS In patients with T2DM (N = 59) we observed significantly greater muscle sodium content (diabetes: 20.6 ± 3.5 vs hypertension: 16.3 ± 2.5 mmol/l, p < 0.001) and skin sodium content (diabetes: 24.5 ± 7.2 vs hypertension: 20.6 ± 5.7 mmol/l, p = 0.01) than in those with primary hypertension (N = 33). When potential confounders (age, body mass index, gender, systolic and diastolic blood pressure, estimated glomerular filtration rate) were entered in a covariance analysis, both skin sodium content (p = 0.037) and muscle sodium content (p < 0.001) were still clearly elevated. CONCLUSION Patients with T2DM have greater skin and muscle sodium content. These are the first known data to demonstrate increased tissue sodium content in patients with T2DM, measured by 23Na magnetic resonance imaging. Since tissue sodium content is related to organ damage, therapeutic intervention should aim at reducing tissue sodium content.
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Affiliation(s)
- Dennis Kannenkeril
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Marina V Karg
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Agnes Bosch
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany; Paracelsus Medical School Nürnberg, Nürnberg, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany; Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany.
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Santos-Rocha J, Lima-Leal GA, Moreira HS, Ramos-Alves FE, de Sá FG, Duarte GP, Xavier FE. Maternal high-sodium intake affects the offspring' vascular renin-angiotensin system promoting endothelial dysfunction in rats. Vascul Pharmacol 2019; 115:33-45. [PMID: 30790705 DOI: 10.1016/j.vph.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/17/2018] [Accepted: 02/17/2019] [Indexed: 01/13/2023]
Abstract
Perinatal sodium overload induces endothelial dysfunction in adult offspring, but the underlying mechanisms are not fully known. The involvement of tissue renin-angiotensin system on high sodium-programmed endothelial dysfunction was examined. Acetylcholine and angiotensin I and II responses were analyzed in aorta and mesenteric resistance arteries from 24-week-old male offspring of normal-salt (O-NS, 1.3% NaCl) and high-salt (O-HS, 8% NaCl) fed dams. COX-2 expression, O2- production and angiotensin converting enzyme (ACE) activity were determined. A separated O-HS was treated with losartan (15 mg kg-1/day) for eight weeks. Compared to O-NS, O-HS were normotensive. Acetylcholine-induced relaxation was impaired in O-HS arteries, which was improved by tempol, apocynin or indomethacin. The angiotensin I-induced contraction was greater in O-HS arteries, whereas the angiotensin II responses were unchanged. ACE activity, O2- production and COX-2 expression were increased in O-HS arteries. In this group, the increased O2- production was inhibited by apocynin or losartan. Chronic losartan decreased COX-2 expression and restored the endothelium-dependent vasodilation in O-HS. Our findings reiterate that perinatal sodium overload programs endothelial dysfunction in adult offspring through a blood pressure-independent mechanism. Our results also suggest that vascular angiotensin II is the main mediator of high sodium-programmed endothelial dysfunction, promoting COX-2 expression and oxidative stress.
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Affiliation(s)
- Juliana Santos-Rocha
- Departamento de Fisiologia e Farmacologia, Universidade Federal de Pernambuco, Recife, Brazil
| | - Geórgia A Lima-Leal
- Departamento de Fisiologia e Farmacologia, Universidade Federal de Pernambuco, Recife, Brazil
| | - Hicla S Moreira
- Departamento de Fisiologia e Farmacologia, Universidade Federal de Pernambuco, Recife, Brazil
| | - Fernanda E Ramos-Alves
- Departamento de Fisiologia e Farmacologia, Universidade Federal de Pernambuco, Recife, Brazil
| | - Francine G de Sá
- Departamento de Fisiologia e Farmacologia, Universidade Federal de Pernambuco, Recife, Brazil
| | - Gloria P Duarte
- Departamento de Fisiologia e Farmacologia, Universidade Federal de Pernambuco, Recife, Brazil
| | - Fabiano E Xavier
- Departamento de Fisiologia e Farmacologia, Universidade Federal de Pernambuco, Recife, Brazil.
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Neves MF, Cunha AR, Cunha MR, Gismondi RA, Oigman W. The Role of Renin-Angiotensin-Aldosterone System and Its New Components in Arterial Stiffness and Vascular Aging. High Blood Press Cardiovasc Prev 2018; 25:137-145. [PMID: 29476451 DOI: 10.1007/s40292-018-0252-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 02/12/2018] [Indexed: 01/13/2023] Open
Abstract
Many cardiovascular diseases present renin-angiotensin-aldosterone system (RAAS) hyperactivity as an important pathophysiological mechanism to be target in the therapeutic approaches. Moreover, arterial stiffness is currently considered as a new independent risk factor for cardiovascular disease in different clinical conditions, including hypertension and chronic kidney disease. In fact, excessive stimulation of angiotensin type 1 (AT1) receptors, as well as mineralocorticoid receptors, results in cellular growth, oxidative stress and vascular inflammation, which may lead to arterial stiffness and accelerate the process of vascular aging. In the last decades, a vasoprotective axis of the RAAS has been discovered, and now it is well established that new components with antioxidant and anti-inflammatory properties play important roles promoting vasodilation, natriuresis and reducing collagen deposition, thus attenuating arterial stiffness and improving endothelial function. In this review, we will focus on these pathophysiological mechanisms and the relevance of RAAS inhibition by different strategies to increase arterial compliance and to decelerate vascular aging.
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Affiliation(s)
- Mario Fritsch Neves
- Departamento de Clinica Medica, Universidade do Estado do Rio de Janeiro, Ave. 28 de Setembro, 77 sala 329, Rio De Janeiro, 20551-030, Brazil.
| | - Ana Rosa Cunha
- Departamento de Clinica Medica, Universidade do Estado do Rio de Janeiro, Ave. 28 de Setembro, 77 sala 329, Rio De Janeiro, 20551-030, Brazil
| | - Michelle Rabello Cunha
- Departamento de Clinica Medica, Universidade do Estado do Rio de Janeiro, Ave. 28 de Setembro, 77 sala 329, Rio De Janeiro, 20551-030, Brazil
| | - Ronaldo Altenburg Gismondi
- Centro de Ciências Médicas, Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Niterói, RJ, 24033-900, Brazil
| | - Wille Oigman
- Departamento de Clinica Medica, Universidade do Estado do Rio de Janeiro, Ave. 28 de Setembro, 77 sala 329, Rio De Janeiro, 20551-030, Brazil
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Clemmer JS, Hester RL, Pruett WA. Simulating a virtual population's sensitivity to salt and uninephrectomy. Interface Focus 2017; 8:20160134. [PMID: 29285341 DOI: 10.1098/rsfs.2016.0134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Salt sensitivity, with or without concomitant hypertension, is associated with increased mortality. Reduced functional renal mass plays an important role in causing salt-sensitive hypertension for many individuals. Factors that are important in the condition of decreased renal mass and how they affect blood pressure (BP) or salt sensitivity are unclear. We used HumMod, an integrative mathematical model of human physiology, to create a heterogeneous population of 1000 virtual patients by randomly varying physiological parameters. We examined potential physiological mechanisms responsible for the change in BP in response to high-salt diet (8× change in salt intake for three weeks) with full kidney mass and again after the removal of one kidney in the same group of virtual patients. We used topological data analysis (TDA), a clustering algorithm tool, to analyse the large dataset and separate patient subpopulations. TDA distinguished five unique clusters of salt-sensitive individuals (more than 15 mmHg change in BP with increased salt). While these clusters had similar BP responses to salt, different collections of variables were responsible for their salt sensitivity, e.g. greater reductions in glomerular filtration rate (GFR) or impairments in the renin-angiotensin system. After simulating uninephrectomy in these virtual patients, the three most salt-sensitive clusters were associated with a blunted increase in renal blood flow (RBF) and higher increase in loop and distal sodium reabsorption when compared with the salt-resistant population. These data suggest that the suppression of sodium reabsorption and renin-angiotensin system is key for salt resistance, and RBF in addition to GFR may be an important factor when considering criteria for kidney donors. Here, we show that in our model of human physiology, different derangements result in the same phenotype. While these concepts are known in the experimental community, they were derived here by considering only the data obtained from our virtual experiments. These methodologies could potentially be used to discover patterns in patient sensitivity to dietary change or interventions and could be a revolutionary tool in personalizing medicine.
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Affiliation(s)
- John S Clemmer
- Department of Physiology and Biophysics, Center for Computational Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Robert L Hester
- Department of Physiology and Biophysics, Center for Computational Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - W Andrew Pruett
- Department of Physiology and Biophysics, Center for Computational Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Excess Body Weight, Insulin Resistance and Isolated Systolic Hypertension: Potential Pathophysiological Links. High Blood Press Cardiovasc Prev 2017; 25:17-23. [DOI: 10.1007/s40292-017-0240-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/25/2017] [Indexed: 12/24/2022] Open
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Larson RA, Chapp AD, Gui L, Huber MJ, Cheng ZJ, Shan Z, Chen QH. High Salt Intake Augments Excitability of PVN Neurons in Rats: Role of the Endoplasmic Reticulum Ca 2+ Store. Front Neurosci 2017; 11:182. [PMID: 28428739 PMCID: PMC5382644 DOI: 10.3389/fnins.2017.00182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/20/2017] [Indexed: 11/17/2022] Open
Abstract
High salt (HS) intake sensitizes central autonomic circuitry leading to sympathoexcitation. However, its underlying mechanisms are not fully understood. We hypothesized that inhibition of PVN endoplasmic reticulum (ER) Ca2+ store function would augment PVN neuronal excitability and sympathetic nerve activity (SNA). We further hypothesized that a 2% (NaCl) HS diet for 5 weeks would reduce ER Ca2+ store function and increase excitability of PVN neurons with axon projections to the rostral ventrolateral medulla (PVN-RVLM) identified by retrograde label. PVN microinjection of the ER Ca2+ ATPase inhibitor thapsigargin (TG) increased SNA and mean arterial pressure (MAP) in a dose-dependent manner in rats with a normal salt (NS) diet (0.4%NaCl). In contrast, sympathoexcitatory responses to PVN TG were significantly (p < 0.05) blunted in HS treated rats compared to NS treatment. In whole cell current-clamp recordings from PVN-RVLM neurons, graded current injections evoked graded increases in spike frequency. Maximum discharge was significantly augmented (p < 0.05) by HS diet compared to NS group. Bath application of TG (0.5 μM) increased excitability of PVN-RVLM neurons in NS (p < 0.05), yet had no significant effect in HS rats. Our data indicate that HS intake augments excitability of PVN-RVLM neurons. Inhibition of the ER Ca2+-ATPase and depletion of Ca2+ store likely plays a role in increasing PVN neuronal excitability, which may underlie the mechanisms of sympathoexcitation in rats with chronic HS intake.
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Affiliation(s)
- Robert A. Larson
- Department of Kinesiology and Integrative Physiology, Michigan Technological UniversityHoughton, MI, USA
| | - Andrew D. Chapp
- Department of Kinesiology and Integrative Physiology, Michigan Technological UniversityHoughton, MI, USA
| | - Le Gui
- Department of Kinesiology and Integrative Physiology, Michigan Technological UniversityHoughton, MI, USA
- Department of Cardiology, Affiliated Hospital of Nantong UniversityNantong, China
| | - Michael J. Huber
- Department of Kinesiology and Integrative Physiology, Michigan Technological UniversityHoughton, MI, USA
| | - Zixi Jack Cheng
- Biomolecular Science Center, Burnett School of Biomedical Sciences, College of Medicine, University of Central FloridaOrlando, FL, USA
| | - Zhiying Shan
- Department of Kinesiology and Integrative Physiology, Michigan Technological UniversityHoughton, MI, USA
| | - Qing-Hui Chen
- Department of Kinesiology and Integrative Physiology, Michigan Technological UniversityHoughton, MI, USA
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Huang YP, Jin HY, Yu HP. Inhibitory effects of alpha-lipoic acid on oxidative stress in the rostral ventrolateral medulla in rats with salt-induced hypertension. Int J Mol Med 2016; 39:430-436. [PMID: 28035366 DOI: 10.3892/ijmm.2016.2846] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 12/21/2016] [Indexed: 11/06/2022] Open
Abstract
Oxidative stress in the rostral ventrolateral medulla (RVLM) plays an important role in the pathophysiology of hypertension. Alpha‑lipoic acid (ALA) is widely recognized for its potent superoxide inhibitory properties, and it can safely penetrate deep into the brain. The aim of this study was to explore whether ALA supplementation attenuates hypertensive responses and cardiac hypertrophy by decreasing the NAD(P)H oxidase (NOX)-derived overproduction of reactive oxygen species (ROS) in the mitochondria in the RVLM, and thus attenuating the development of salt‑induced hypertension. For this purpose, male Wistar rats were randomly divided into 2 groups and either fed a high-salt diet or not. After 8 weeks, the rats were either administered ALA or an equal volume of the vehicle for 8 weeks. The rats fed a high‑salt diet exhibited higher mean arterial pressure (MAP) and higher plasma noradrenaline (NE) levels, as well as cardiac hypertrophy, as evidence by the increased whole heart weight/body weight (WHW/BW) ratio, WHW/tibia length (TL) ratio and left‑ventricular weight (LVW)/TL ratio. Compared with the rats in the NS group, the rats in the HS group only exhibited increased levels of superoxide, NOX2, NOX4 and mitochondrial malondialdehyde (MDA), but also decreased levels of copper/zinc (Cu/Zn)-superoxide dismutase (SOD), mitochondrial SOD and glutathione (GSH) in the RVLM. The supplementation of ALA decreased MAP, plasma NE levels and the levels of cardiac hypertrophy indicators. It also decreased the levels of superoxide, NOX2, NOX4 and mitochondrial MDA, and increased the levels of Cu/Zn‑SOD, mitochondrial SOD and GSH in the RVLM compared with the rats fed a high-salt diet and not treated with ALA. On the whole, our findings indicate that long‑term ALA supplementation attenuates hypertensive responses and cardiac hypertrophy by decreasing the expression of NAD(P)H subunits (NOX2 and NOX4), increasing the levels of mitochondrial bioenergetic enzymes, and enhancing the intracellular antioxidant capacity in the RVLM during the development of hypertension.
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Affiliation(s)
- Yu-Peng Huang
- Department of Cardiovascular Medicine, Hanyang Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Hong-Yan Jin
- Department of Cardiovascular Medicine, Hanyang Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Hui-Ping Yu
- Department of Cardiovascular Medicine, Hanyang Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
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Affiliation(s)
- John E Hall
- From the Department of Physiology and Biophysics, Mississippi Center for Obesity Research, University of Mississippi Medical Center, Jackson.
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Mills KT, Chen J, Yang W, Appel LJ, Kusek JW, Alper A, Delafontaine P, Keane MG, Mohler E, Ojo A, Rahman M, Ricardo AC, Soliman EZ, Steigerwalt S, Townsend R, He J. Sodium Excretion and the Risk of Cardiovascular Disease in Patients With Chronic Kidney Disease. JAMA 2016; 315:2200-10. [PMID: 27218629 PMCID: PMC5087595 DOI: 10.1001/jama.2016.4447] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Patients with chronic kidney disease (CKD) are at an increased risk of cardiovascular disease (CVD) compared with the general population. Prior studies have produced contradictory results on the association of dietary sodium intake with risk of CVD, and this relationship has not been investigated in patients with CKD. OBJECTIVE To evaluate the association between urinary sodium excretion and clinical CVD events among patients with CKD. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study of patients with CKD from 7 locations in the United States enrolled in the Chronic Renal Insufficiency Cohort Study and followed up from May 2003 to March 2013. EXPOSURES The cumulative mean of urinary sodium excretion from three 24-hour urinary measurements and calibrated to sex-specific mean 24-hour urinary creatinine excretion. MAIN OUTCOMES AND MEASURES A composite of CVD events defined as congestive heart failure, stroke, or myocardial infarction. Events were reported every 6 months and confirmed by medical record adjudication. RESULTS Among 3757 participants (mean age, 58 years; 45% women), 804 composite CVD events (575 heart failure, 305 myocardial infarction, and 148 stroke) occurred during a median 6.8 years of follow-up. From lowest (<2894 mg/24 hours) to highest (≥4548 mg/24 hours) quartile of calibrated sodium excretion, 174, 159, 198, and 273 composite CVD events occurred, and the cumulative incidence was 18.4%, 16.5%, 20.6%, and 29.8% at median follow-up. In addition, the cumulative incidence of CVD events in the highest quartile of calibrated sodium excretion compared with the lowest was 23.2% vs 13.3% for heart failure, 10.9% vs 7.8% for myocardial infarction, and 6.4% vs 2.7% for stroke at median follow-up. Hazard ratios of the highest quartile compared with the lowest quartile were 1.36 (95% CI, 1.09-1.70; P = .007) for composite CVD events, 1.34 (95% CI, 1.03-1.74; P = .03) for heart failure, and 1.81 (95% CI, 1.08-3.02; P = .02) for stroke after multivariable adjustment. Restricted cubic spline analyses of the association between sodium excretion and composite CVD provided no evidence of a nonlinear association (P = .11) and indicated a significant linear association (P < .001). CONCLUSIONS AND RELEVANCE Among patients with CKD, higher urinary sodium excretion was associated with increased risk of CVD.
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Affiliation(s)
- Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana2Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Wei Yang
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - John W Kusek
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Arnold Alper
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Patrice Delafontaine
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Martin G Keane
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Emile Mohler
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Akinlolu Ojo
- Department of Medicine, University of Michigan, Ann Arbor
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, Ohio10Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Ana C Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago
| | - Elsayed Z Soliman
- Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Raymond Townsend
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana2Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
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Baldo MP, Rodrigues SL, Mill JG. High salt intake as a multifaceted cardiovascular disease: new support from cellular and molecular evidence. Heart Fail Rev 2016; 20:461-74. [PMID: 25725616 DOI: 10.1007/s10741-015-9478-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Scientists worldwide have disseminated the idea that increased dietary salt increases blood pressure. Currently, salt intake in the general population is ten times higher than that consumed in the past and at least two times higher than the current recommendation. Indeed, a salt-rich diet increases cardiovascular morbidity and mortality. For a long time, however, the deleterious effects associated with high salt consumption were only related to the effect of salt on blood pressure. Currently, several other effects have been reported. In some cases, the deleterious effects of high salt consumption are independently associated with other common risk factors. In this article, we gather data on the effects of increased salt intake on the cardiovascular system, from infancy to adulthood, to describe the route by which increased salt intake leads to cardiovascular diseases. We have reviewed the cellular and molecular mechanisms through which a high intake of salt acts on the cardiovascular system to lead to the progressive failure of a healthy heart.
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Affiliation(s)
- Marcelo Perim Baldo
- Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, Vitória, ES, 29042-755, Brazil,
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Salt Intake and Health Risk in Climate Change Vulnerable Coastal Bangladesh: What Role Do Beliefs and Practices Play? PLoS One 2016; 11:e0152783. [PMID: 27044049 PMCID: PMC4820263 DOI: 10.1371/journal.pone.0152783] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/18/2016] [Indexed: 11/19/2022] Open
Abstract
Background High salt consumption is an important risk factor of elevated blood pressure. In Bangladesh about 20 million people are at high risk of hypertension due to climate change induced saline intrusion in water. The objective of this study is to assess beliefs, perceptions, and practices associated with salt consumption in coastal Bangladesh. Methods The study was conducted in Chakaria, Bangladesh between April-June 2011. It was a cross sectional mixed method study. For the qualitative study 6 focus group discussions, 8 key informant interviews, 60 free listing exercises, 20 ranking exercises and 10 observations were conducted. 400 adults were randomly selected for quantitative survey. For analysis we used SPSS for quantitative data, and Anthropac and Nvivo for qualitative data. Results Salt was described as an essential component of food with strong cultural and religious roots. People described both health benefits and risks related to salt intake. The overall risk perception regarding excessive salt consumption was low and respondents believed that the cooking process can render the salt harmless. Respondents were aware that salt is added in many foods even if they do not taste salty but did not recognize that salt can occur naturally in both foods and water. Conclusions In the study community people had low awareness of the risks associated with excess salt consumption and salt reduction strategies were not high in their agenda. The easy access to and low cost of salt as well as unrecognised presence of salt in drinking water has created an environment conducive to excess salt consumption. It is important to design general messages related to salt reduction and test tailored strategies especially for those at high risk of hypertension.
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Abarquez RF, Reganit PFM, Chungunco CN, Alcover J, Punzalan FER, Reyes EB, Cunanan EL. Chronic Heart Failure Clinical Practice Guidelines' Class 1-A Pharmacologic Recommendations: Start-to-End Synergistic Drug Therapy? ASEAN HEART JOURNAL : OFFICIAL JOURNAL OF THE ASEAN FEDERATION OF CARDIOLOGY 2016; 24:4. [PMID: 27054142 PMCID: PMC4781891 DOI: 10.7603/s40602-016-0004-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic heart failure (HF) disease as an emerging epidemic has a high economic-psycho-social burden, hospitalization, readmission, morbidity and mortality rates despite many clinical practice guidelines' evidenced-based and consensus driven recommendations that include trials' initial-baseline data. OBJECTIVE To show that the survival and hospitalization-free event rates in the reviewed chronic HF clinical practice guidelines' class I-A recommendations as initial HF drug therapy (IDT) is possibly a combination and 'start-to-end' synergistic effect of the add-on ('end') HF drug therapy (ADT) to the baseline ('start') HF drug therapy (BDT). METHODOLOGY The references cited in the chronic HF clinical practice guidelines of the 2005, 2009, and 2013 American Heart Association/American College of Cardiology (AHA/ACC), the 2006 Heart Failure Society of America (HFSA), and the 2005, 2008, and 2012 European Society of Cardiology (ESC) were reviewed and compared with the respective guidelines' and other countries' recommendations. RESULTS The BDT using glycosides and diuretics is 79%-100% in the cited HF trials. The survival rates attributed to the BDT ('start') is 46%-89% and IDT ('end') 61%-92.8%, respectively. The hospitalization-free event rate of the BDT group: 47.1% to 85.3% and IDT group 61.8%-90%, respectively. Thus, the survival and hospitalization-free event rates of the ADT is 0.4%-15% and 4.6% to 14.7%, respectively. The extrapolated BDT survival is 8%-51% based on a 38% estimated natural HF survival rate for the time period109. CONCLUSION The contribution of baseline HF drug therapy (BDT) is relevant in terms of survival and hospitalization-free event rates compared to the HF class 1-A guidelines initial drug therapy recommendations (IDT). Further, the proposed initial HF drug ('end') therapy (IDT) has possible synergistic effects with the baseline HF drug ('start') therapy (BDT) and is essentially the add on HF drug therapy (ADT) in our analysis. The polypharmacy HF treatment is a synergistic effect due to BDT and ADT.
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Affiliation(s)
- Ramon F. Abarquez
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Paul Ferdinand M. Reganit
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Carmen N. Chungunco
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Jean Alcover
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Felix Eduardo R. Punzalan
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Eugenio B. Reyes
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Elleen L. Cunanan
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
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Zhang T, Fang S, Wan C, Kong Q, Wang G, Wang S, Zhang H, Zou H, Sun B, Sun W, Zhang Y, Mu L, Wang J, Wang J, Zhang H, Wang D, Li H. Excess salt exacerbates blood-brain barrier disruption via a p38/MAPK/SGK1-dependent pathway in permanent cerebral ischemia. Sci Rep 2015; 5:16548. [PMID: 26549644 PMCID: PMC4637879 DOI: 10.1038/srep16548] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 10/15/2015] [Indexed: 12/16/2022] Open
Abstract
High salt diet (HSD) is one of the most important risk factors that contribute to many vascular diseases including ischemic stroke. One proposed mechanism underlying the disruption of blood-brain barrier (BBB) mediated by HSD is indirectly through enhancing blood pressure. The direct role of HSD on BBB integrity is unclear. Our purpose is to determine whether and how HSD might be involved in BBB breakdown during ischemia. To test that, we induced model of cerebral ischemia by permanent middle cerebral artery ligation (pMCAL) in either normal diet or HSD fed mice. We observed that HSD significantly enhanced ischemic brain damage which was associated with enhanced BBB disruption, increased leukocytes infiltration and loss of tight junction (TJ) proteins expression without apparently altering blood pressure. Our in vitro experiment also revealed that sodium chloride (NaCl) treatment down-regulated TJ protein expression by endothelial cells and substantially increased BBB permeability during starvation. Inhibition of p38/MAPK/SGK1 pathway eliminated the effect of NaCl on BBB permeability in vitro. In addition, we noticed a positive correlation between urinary sodium levels and ischemic lesion size in stroke patients. Together, our study demonstrates a hypertension-independent role of HSD during ischemia and provides rationale for post cerebral ischemic attack management.
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Affiliation(s)
- Tongshuai Zhang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Shaohong Fang
- The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Harbin, China 150081
| | - Cong Wan
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Qingfei Kong
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Guangyou Wang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Shuangshuang Wang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Haoqiang Zhang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Haifeng Zou
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Bo Sun
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Wei Sun
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China 150081
| | - Yao Zhang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Lili Mu
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Jinghua Wang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Jing Wang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China 150081
| | - Haiyu Zhang
- Department of Epidemiology and Biostatistics, Harbin Medical University, Harbin, China 150081
| | - Dandan Wang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Hulun Li
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
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Lakatos O, Györke Z, Sulyok E. Sodium and potassium intake in Hungarian children and adolescents: Comparison of two cross sectional studies. ACTA ALIMENTARIA 2015. [DOI: 10.1556/aalim.44.2015.1.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sarikaya H, Ferro J, Arnold M. Stroke Prevention - Medical and Lifestyle Measures. Eur Neurol 2015; 73:150-7. [DOI: 10.1159/000367652] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 08/17/2014] [Indexed: 11/19/2022]
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Wei L, Mackenzie IS, MacDonald TM, George J. Cardiovascular risk associated with sodium-containing medicines. Expert Opin Drug Saf 2014; 13:1515-23. [DOI: 10.1517/14740338.2014.970163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Simmonds SS, Lay J, Stocker SD. Dietary salt intake exaggerates sympathetic reflexes and increases blood pressure variability in normotensive rats. Hypertension 2014; 64:583-9. [PMID: 24914195 DOI: 10.1161/hypertensionaha.114.03250] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Previous studies have reported that chronic increases in dietary salt intake enhance sympathetic nerve activity and arterial blood pressure (ABP) responses evoked from brain stem nuclei of normotensive, salt-resistant rats. The purpose of the present study was to determine whether this sensitization results in exaggerated sympathetic nerve activity and ABP responses during activation of various cardiovascular reflexes and also increases ABP variability. Male Sprague-Dawley rats were fed 0.1% NaCl chow (low), 0.5% NaCl chow (medium), 4.0% NaCl chow (high) for 14 to 17 days. Then, the animals were prepared for recordings of lumbar, renal, and splanchnic sympathetic nerve activity and ABP. The level of dietary salt intake directly correlated with the magnitude of sympathetic nerve activity and ABP responses to electrical stimulation of sciatic afferents or intracerebroventricular infusion of 0.6 mol/L or 1.0 mol/L NaCl. Similarly, there was a direct correlation between the level of dietary salt intake and the sympathoinhibitory responses produced by acute volume expansion and stimulation of the aortic depressor nerve or cervical vagal afferents. In contrast, dietary salt intake did not affect the sympathetic and ABP responses to chemoreflex activation produced by hypoxia or hypercapnia. Chronic lesion of the anteroventral third ventricle region eliminated the ability of dietary salt intake to modulate these cardiovascular reflexes. Finally, rats chronically instrumented with telemetry units indicate that increased dietary salt intake elevated blood pressure variability but not mean ABP. These findings indicate that dietary salt intake works through the forebrain hypothalamus to modulate various centrally mediated cardiovascular reflexes and increase blood pressure variability.
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Affiliation(s)
- Sarah S Simmonds
- From the Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey
| | - Jennifer Lay
- From the Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey
| | - Sean D Stocker
- From the Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey.
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Antman EM, Appel LJ, Balentine D, Johnson RK, Steffen LM, Miller EA, Pappas A, Stitzel KF, Vafiadis DK, Whitsel L. Stakeholder discussion to reduce population-wide sodium intake and decrease sodium in the food supply: a conference report from the American Heart Association Sodium Conference 2013 Planning Group. Circulation 2014; 129:e660-79. [PMID: 24799511 DOI: 10.1161/cir.0000000000000051] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND A 2-day interactive forum was convened to discuss the current status and future implications of reducing sodium in the food supply and to identify opportunities for stakeholder collaboration. METHODS AND RESULTS Participants included 128 stakeholders engaged in food research and development, food manufacturing and retail, restaurant and food service operations, regulatory and legislative activities, public health initiatives, healthcare, academia and scientific research, and data monitoring and surveillance. Presentation topics included scientific evidence for sodium reduction and public health policy recommendations; consumer sodium intakes, attitudes, and behaviors; food technologies and solutions for sodium reduction and sensory implications; experiences of the food and dining industries; and translation and implementation of sodium intake recommendations. Facilitated breakout sessions were conducted to allow for sharing of current practices, insights, and expertise. CONCLUSIONS A well-established body of scientific research shows that there is a strong relationship between excess sodium intake and high blood pressure and other adverse health outcomes. With Americans getting >75% of their sodium from processed and restaurant food, this evidence creates mounting pressure for less sodium in the food supply. The reduction of sodium in the food supply is a complex issue that involves multiple stakeholders. The success of new technological approaches for reducing sodium will depend on product availability, health effects (both intended and unintended), research and development investments, quality and taste of reformulated foods, supply chain management, operational modifications, consumer acceptance, and cost. The conference facilitated an exchange of ideas and set the stage for potential collaboration opportunities among stakeholders with mutual interest in reducing sodium in the food supply and in Americans' diets. Population-wide sodium reduction remains a critically important component of public health efforts to promote cardiovascular health and prevent cardiovascular disease and will remain a priority for the American Heart Association.
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Susic D, Frohlich ED. Telmisartan improves survival and ventricular function in SHR rats with extensive cardiovascular damage induced by dietary salt excess. ACTA ACUST UNITED AC 2014; 8:297-302. [DOI: 10.1016/j.jash.2014.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 02/21/2014] [Accepted: 02/22/2014] [Indexed: 01/22/2023]
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Kenerson JG. Hypertension in Haiti: the challenge of best possible practice. J Clin Hypertens (Greenwich) 2014; 16:107-14. [PMID: 24400884 PMCID: PMC8031758 DOI: 10.1111/jch.12242] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/10/2013] [Indexed: 12/17/2022]
Abstract
On the fourth anniversary, it is impossible to discuss hypertension in Haiti without acknowledging the almost incalculable negative impact of the January 12, 2010 earthquake. It was catastrophic not only in terms of death and physical injury, but also the widespread destruction of a tenuous infrastructure and public health system. Yet, paradoxically, this virtual blank slate could be an opportunity to develop an innovative pragmatic approach to the equally devastating problem of hypertension as the most common contributing cause of death in Haiti. Rising Phoenix-like literally from the ashes and rubble, there are lessons to be learned from the Haiti experience, as a potential model for the management of hypertension in the community in low resource venues in the Caribbean and beyond. Haiti has very poor comparative outcomes, and specific challenges related to high prevalence stroke, renal failure, and heart failure as negative prognostic consequences of undiagnosed and uncontrolled hypertension. There are severe public health challenges related to salt education, as well as societal challenges related to negative social determinants of health and disease, and the structural violence of overwhelming poverty. Pragmatism is necessary as we attempt to combine the tenets of evidence based medicine with reality based medicine restrictions imposed by low resource. It is through the generation of Best Possible Practice (BPP) models of care that colleagues can develop systems of mutual knowledge sharing, service, and support. This approach extends to screening and diagnosis, where there is no electricity for semi- or automatic manometric devices and requisite need to train in manual/ auscultatory technique, to education and curricula built specifically around a flexible hypertension community management guideline as the accepted standard to aspire to. A successful approach requires solid guiding principles, including a commitment to best attainable quality and value(s). It also requires standing together as a community of dedicated medical professionals.
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Frohlich ED. Left ventricular hypertrophy: a major factor of risk in Black hypertensive patients. Am J Hypertens 2014; 27:1-2. [PMID: 24242824 DOI: 10.1093/ajh/hpt214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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De Mello WC, Frohlich ED. Clinical perspectives and fundamental aspects of local cardiovascular and renal Renin-Angiotensin systems. Front Endocrinol (Lausanne) 2014; 5:16. [PMID: 24600438 PMCID: PMC3928588 DOI: 10.3389/fendo.2014.00016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 02/06/2014] [Indexed: 01/13/2023] Open
Abstract
Evidence for the potential role of organ specific cardiovascular renin-angiotensin systems (RAS) has been demonstrated experimentally and clinically with respect to certain cardiovascular and renal diseases. These findings have been supported by studies involving pharmacological inhibition during ischemic heart disease, myocardial infarction, cardiac failure; hypertension associated with left ventricular ischemia, myocardial fibrosis and left ventricular hypertrophy; structural and functional changes of the target organs associated with prolonged dietary salt excess; and intrarenal vascular disease associated with end-stage renal disease. Moreover, the severe structural and functional changes induced by these pathological conditions can be prevented and reversed by agents producing RAS inhibition (even when not necessarily coincident with alterations in arterial pressure). In this review, we discuss specific fundamental and clinical aspects and mechanisms related to the activation or inhibition of local RAS and their implications for cardiovascular and renal diseases. Fundamental aspects involving the role of angiotensins on cardiac and renal functions including the expression of RAS components in the heart and kidney and the controversial role of angiotensin-converting enzyme 2 on angiotensin peptide metabolism in humans, were discussed.
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Affiliation(s)
- Walmor C. De Mello
- School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
- *Correspondence: Walmor C. De Mello, School of Medicine, University of Puerto Rico Medical Sciences Campus, Suite A-322, Main Building, San Juan, PR 00936-5067, USA e-mail:
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Thomas F, Pannier B, Safar ME. Impact of country of birth on progression of steady and pulsatile hemodynamic parameters in normotensive and hypertensive subjects. ACTA ACUST UNITED AC 2013; 7:440-7. [DOI: 10.1016/j.jash.2013.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/05/2013] [Accepted: 07/08/2013] [Indexed: 01/13/2023]
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Grabowski K, Koplin G, Aliu B, Schulte L, Schulz A, Kreutz R. Mapping and confirmation of a major left ventricular mass QTL on rat chromosome 1 by contrasting SHRSP and F344 rats. Physiol Genomics 2013; 45:827-33. [PMID: 23901062 DOI: 10.1152/physiolgenomics.00067.2013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
An abnormal increase in left ventricular (LV) mass, i.e., LV hypertrophy (LVH), represents an important target organ damage in arterial hypertension and has been associated with poor clinical outcome. Genetic factors are contributing to variation in LV mass in addition to blood pressure and other factors such as dietary salt intake. We set out to map quantitative trait loci (QTL) for LV mass by comparing the spontaneously hypertensive stroke-prone (SHRSP) rat with LVH and normotensive Fischer rats (F344) with contrasting low LV mass. To this end we performed a genome-wide QTL mapping analysis in 232 F2 animals derived from SHRSP and F344 exposed to high-salt (4% in chow) intake for 8 wk. We mapped one major QTL for LV mass on rat chromosome 1 (RNO1) that demonstrated strong linkage (peak logarithm of odds score 8.4) to relative LV weight (RLVW) and accounted for ∼19% of the variance of this phenotype in F2 rats. We therefore generated a consomic SHRSP-1(F344) strain in which RNO1 from F344 was introgressed into the SHRSP background. Consomic and SHRSP animals showed similar blood pressures during conventional intra-arterial measurements, while RLVW was already significantly lower (-17.7%, P<0.05) in SHRSP-1(F344) in response to a normal-salt diet; a similar significant reduction of LV mass was also observed in consomic rats after high-salt intake (P<0.05 vs. SHRSP). Thus, a major QTL on RNO1 was confirmed with significant impact on LV mass in the hypertensive background of SHRSP.
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Affiliation(s)
- Katja Grabowski
- Department of Clinical Pharmacology and Toxicology, CharitéCentrum für Therapieforschung, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Thomas F, Pannier B, Safar ME. Impact of country of birth on arterial function in subjects living in France. ACTA ACUST UNITED AC 2013. [PMID: 23199672 DOI: 10.1016/j.jash.2012.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Affect of country of birth on arterial function in subjects (14,818 men and 9121 women) living in Paris but born in France or elsewhere in Europe (67%), Africa (25%), Asia (5%), and French Overseas Departments and Territories (3%) was investigated. Pulsatile hemodynamics involved central augmentation index (CAI) and central (carotid) pulse pressure (CPP). In African-born subjects compared with those born in France, age, blood pressure, overweight, and diabetes were factors associated with hypertension, but cardiovascular and renal impairment were absent. Asian-born subjects differed from others with lower body weight and high-density lipoprotein (HDL)-cholesterol, but higher plasma triglycerides and heart rate. Men's and women's pulsatile changes revealed significant interactions with CAI, and to a lesser extent with CPP, between gender and country of birth, particularly for African- and European-born subjects. For all the latter countries, increased cardiovascular risk of mortality, evaluated with Framingham scores, was highly significant but mainly for men. These data show that country-of-birth impact necessitated subdividing populations into men and women; at-risk populations were born in Africa, Asia, and Europe but less frequently in France; factors involving country-of-birth impact require further research on hereditary and environmental (frequently socioeconomic) factors but also geography and climate.
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Mak GS, Sawaya H, Khan AM, Arora P, Martinez A, Ryan A, Ernande L, Newton-Cheh C, Wang TJ, Scherrer-Crosbie M. Effects of subacute dietary salt intake and acute volume expansion on diastolic function in young normotensive individuals. Eur Heart J Cardiovasc Imaging 2013; 14:1092-8. [PMID: 23515219 DOI: 10.1093/ehjci/jet036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS Chronic excess salt intake may have blood pressure-independent adverse effects on the heart such as myocardial hypertrophy and fibrosis. Effects of subacute sodium loading with excess dietary salt on diastolic function in normotensive individuals have been conflicting and the mechanisms are poorly understood. METHODS AND RESULTS Thirteen healthy normotensive subjects (age 24 ± 4 years) entered a 2-week crossover study with 1 week of a low-salt diet <10 mEq/day and 1 week of a high-salt diet >200 mEq/day. At the end of each study week, left ventricular dimensions, systolic, and diastolic function were assessed with echocardiography before and after 2 L of normal saline infusion. One week of high-salt and low-salt diets did not lead to differences in echocardiographic parameters of systolic or diastolic function, even after rapid volume expansion with saline infusion. The peak early diastolic strain rate (SR) increased after volume loading both after completion of low-salt (1.62 ± 0.23/s vs. 1.82 ± 0.14/s, P < 0.05) and high-salt diets (1.67 ± 0.16/s vs. 1.86 ± 0.22/s, P < 0.05). There was a positive correlation between the peak early diastolic SR and the cardiac index (r = 0.52, P = 0.017). CONCLUSION In healthy normotensive individuals, subacute excess dietary sodium intake does not affect diastolic function. The peak early diastolic SR, similar to other mitral Doppler and tissue Doppler parameters of diastolic function, appears to be strongly dependent on pre-load.
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Affiliation(s)
- Gary S Mak
- Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Jablonski KL, Racine ML, Geolfos CJ, Gates PE, Chonchol M, McQueen MB, Seals DR. Dietary sodium restriction reverses vascular endothelial dysfunction in middle-aged/older adults with moderately elevated systolic blood pressure. J Am Coll Cardiol 2013; 61:335-43. [PMID: 23141486 PMCID: PMC3549053 DOI: 10.1016/j.jacc.2012.09.010] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/29/2012] [Accepted: 09/11/2012] [Indexed: 02/01/2023]
Abstract
OBJECTIVES This study sought to determine the efficacy of dietary sodium restriction (DSR) for improving vascular endothelial dysfunction in middle-aged/older adults with moderately elevated systolic blood pressure (SBP) (130-159 mm Hg) and the associated physiological mechanisms. BACKGROUND Vascular endothelial dysfunction develops with advancing age and elevated SBP, contributing to increased cardiovascular risk. DSR lowers BP, but its effect on vascular endothelial function and mechanisms involved are unknown. METHODS Seventeen subjects (11 men and 6 women; mean age, 62 ± 7 years) completed a, randomized crossover study of 4 weeks of both low (DSR) and normal sodium intake. Vascular endothelial function (endothelium-dependent dilation; EDD), nitric oxide (NO)/tetrahydrobiopterin (BH(4)) bioavailability, and oxidative stress-associated mechanisms were assessed following each condition. RESULTS Urinary sodium excretion was reduced by ≈ 50% (to 70 ± 30 mmol/day), and conduit (brachial artery flow-mediated dilation [FMD(BA)]) and resistance (forearm blood flow responses to acetylcholine [FBF(ACh)]) artery EDD were 68% and 42% (peak FBF(ACh)) higher following DSR (p < 0.005). Low sodium markedly enhanced NO-mediated EDD (greater ΔFBF(ACh) with endothelial NO synthase inhibition) without changing endothelial NO synthase expression/activation (Ser 1177 phosphorylation), restored BH(4) bioactivity (less ΔFMD(BA) with acute BH(4)), abolished tonic superoxide suppression of EDD (less ΔFMD(BA) and ΔFBF(ACh) with ascorbic acid infusion), and increased circulating superoxide dismutase activity (all p < 0.05). These effects were independent of ΔSBP. Other subject characteristics/dietary factors and endothelium-independent dilation were unchanged. CONCLUSIONS DSR largely reversed both macro- and microvascular endothelial dysfunction by enhancing NO and BH(4) bioavailability and reducing oxidative stress. Our findings support the emerging concept that DSR induces "vascular protection" beyond that attributable to its BP-lowering effects.
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Affiliation(s)
| | - Matthew L. Racine
- Department of Integrative Physiology, University of Colorado, Boulder, CO 80309
| | - Candace J. Geolfos
- Department of Integrative Physiology, University of Colorado, Boulder, CO 80309
| | | | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Denver Anschutz Medical Center, Aurora, CO 80045
| | - Matthew B. McQueen
- Department of Integrative Physiology, University of Colorado, Boulder, CO 80309
| | - Douglas R. Seals
- Department of Integrative Physiology, University of Colorado, Boulder, CO 80309
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How can diet influence the risk of stroke? Int J Hypertens 2012; 2012:763507. [PMID: 22693656 PMCID: PMC3369476 DOI: 10.1155/2012/763507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/20/2012] [Accepted: 04/04/2012] [Indexed: 02/07/2023] Open
Abstract
Cerebrovascular diseases are the second cause of mortality in the world, and hypertension is considered a main risk factor for occurrence of stroke. The mechanisms responsible for the increased stroke risk remain unclear. However, dietary interventions have been applied in the management and treatment of their risk factors, which include increased blood pressure levels, obesity, diabetes, and dyslipidemia. Further studies should be conducted to assess the effects of carotenoids, flavonoids, n-3 polyunsaturated fats, and lower salt and high glycemic index intake in risk of stroke.
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Piecha G, Koleganova N, Ritz E, Müller A, Fedorova OV, Bagrov AY, Lutz D, Schirmacher P, Gross-Weissmann ML. High salt intake causes adverse fetal programming--vascular effects beyond blood pressure. Nephrol Dial Transplant 2012; 27:3464-76. [PMID: 22431707 DOI: 10.1093/ndt/gfs027] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND High salt intake causes hypertension, adverse cardiovascular outcomes and potentially also blood pressure (BP)-independent target organ damage. Excess salt intake in pregnancy is known to affect BP in the offspring. The present study was designed to assess whether high salt intake in pregnancy affects BP and vascular morphology in the offspring. METHODS Sprague-Dawley rats were fed a standard rodent diet with low-normal (0.15%) or high (8.0%) salt content during pregnancy and lactation. After weaning at 4 weeks of age, offspring were maintained on the same diet or switched to a high- or low-salt diet, respectively. Vascular geometry was assessed in male offspring at 7 and 12 weeks postnatally. RESULTS Up to 12 weeks of age, there was no significant difference in telemetrically measured BP between the groups of offspring. At 12 weeks of age, wall thickness of central (aorta, carotid), muscular (mesenteric) and intrapulmonary arteries was significantly higher in offspring of mothers on a high-salt diet irrespective of the post-weaning diet. This correlated with increased fibrosis of the aortic wall, more intense nitrotyrosine staining as well as elevated levels of marinobufagenin (MBG) and asymmetric dimethyl arginine (ADMA). CONCLUSIONS High salt intake in pregnant rats has long-lasting effects on the modeling of central and muscular arteries in the offspring independent of postnatal salt intake and BP. Circulating MBG and ADMA and local oxidative stress correlate with the adverse vascular modeling.
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Affiliation(s)
- Grzegorz Piecha
- Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany.
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Susic D, Frohlich ED. Salt consumption and cardiovascular, renal, and hypertensive diseases: clinical and mechanistic aspects. Curr Opin Lipidol 2012; 23:11-6. [PMID: 22123673 DOI: 10.1097/mol.0b013e32834d9c52] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review will discuss some relevant and novel studies on the relationship between sodium intake and cardiovascular structure and function, focusing on blood pressure independent effects of salt on the heart, arteries, and kidneys. RECENT FINDINGS Several new reports clearly demonstrate the role of high dietary salt in mediating cardiovascular and renal morbidity and mortality including stroke, myocardial infarction, arterial stiffening, heart failure, and renal insufficiency. A number of recent studies also indicate that in addition to increased sodium intake, simultaneous decrease in potassium intake may aggravate adverse cardiovascular and renal manifestations. SUMMARY It is now generally accepted that there is a direct positive correlation between dietary salt and arterial pressure. Thus, the beneficial effects of dietary salt reduction are, at least in part, due to a decrease in arterial pressure. Furthermore, the beneficial, pressure-independent effects of sodium restriction on the heart, blood vessels, and kidneys are being increasingly recognized, but not generally appreciated.
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Affiliation(s)
- Dinko Susic
- Hypertension Research Laboratory, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
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Wenner MM, Edwards DG, Ray CA, Rose WC, Gardner TJ, Stillabower M, Farquhar WB. Celecoxib does not alter cardiovascular and renal function during dietary salt loading. Clin Exp Pharmacol Physiol 2012; 38:543-9. [PMID: 21631568 DOI: 10.1111/j.1440-1681.2011.05546.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
1. Cyclo-oxygenase-2 (COX-2)-derived prostaglandins are important in controlling sodium excretion and renin release. In the present study, we tested the hypothesis that a clinical dose of celecoxib would impair urinary sodium excretion and elevate blood pressure (BP) during dietary salt loading. 2. Twelve normotensive individuals (mean (± SEM) age 35 ± 2 years) completed two separate 17 day dietary perturbations, one taking 200 mg/day celecoxib (CX2) and the other taking placebo (PL), randomized with a 1 month wash out. The controlled 17 day diet consisted of a 3 day run-in diet, 7 days of a low-salt (LS, 20 mmol sodium/day) diet and 7 days of a high-salt diet (HS, 350 mmol sodium/day) diet. The order in which the diets were applied was randomized. Data were collected on the last day of the LS and HS diets. 3. Plasma and urinary prostaglandins were modestly lower during celecoxib (P < 0.05). Urinary sodium excretion was greater (P < 0.01) during the HS diet (253 ± 10 vs 281 ± 27 mmol/24 h for PL vs CX2, respectively) compared with the LS diet (14 ± 3 vs 17 ± 7 mmol/24 h for PL vs CX2, respectively; P(drug) = 0.26). Celecoxib did not alter creatinine clearance (P > 0.50). Twenty-four hour mean arterial BP was similar during PL (87 ± 2 vs 87 ± 2 mmHg for LS and HS, respectively) and CX2 (88 ± 2 vs 87 ± 2 mmHg for LS and HS, respectively; P = 0.85), with no effect of dietary salt (P > 0.80). Plasma renin activity, angiotensin II and aldosterone were all suppressed with dietary salt loading (P < 0.05), with no effect of drug (P > 0.35). 4. In conclusion, blood pressure and renal function were not adversely affected by celecoxib, even during dietary salt loading. These findings support current guidelines suggesting minimal cardiovascular risks associated with short-term, low-dose use of celecoxib in young to middle-aged adults.
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Affiliation(s)
- Megan M Wenner
- Department of Kinesiology and Applied Physiology, University of Delaware, USA
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Die-Kacou H, Kakou A, Kamagaté M, Yavo JC, Bamba-Kamagaté D, Balayssac E, Daubret-Potey T, Vamy MG. Sodium and Blood Pressure in Africa. Therapie 2011; 66:541-4. [DOI: 10.2515/therapie/2011066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 09/20/2011] [Indexed: 11/20/2022]
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Tomonari T, Fukuda M, Miura T, Mizuno M, Wakamatsu TY, Ichikawa T, Miyagi S, Shirasawa Y, Ito A, Yoshida A, Omori T, Kimura G. Is salt intake an independent risk factor of stroke mortality? Demographic analysis by regions in Japan. ACTA ACUST UNITED AC 2011; 5:456-62. [PMID: 21890446 DOI: 10.1016/j.jash.2011.07.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 07/08/2011] [Accepted: 07/08/2011] [Indexed: 12/15/2022]
Abstract
We reported a remarkable regional difference within Japan in the incidence of end-stage renal disease. Regional differences were also well-known for salt intake, blood pressure (BP), and mortality from stroke, which remains one of the leading causes of death. Noting these regional differences, we examined mutual relationships among salt intake, BP, and stroke mortality in 12 regions of Japan. Data of salt intake, BP, and stroke mortality in 12 regions were collected from National Nutrition Survey (NNS-J), reanalysis of NNS-J, and Vital Statistics of National Population Dynamic Survey (Ministry of Health, Labor and Welfare), respectively. Significant regional differences were found in salt intake (P < .0001), mean arterial BP (P = .0001), and stroke mortality (P < .0001). Although annual changes in these parameters were also significant, their regional differences persisted. Salt intake had positive relationships with both mean arterial BP (r = 0.26, P = .0009) and stroke mortality (r = 0.26, P < .0001) across 12 regions, whereas mean arterial BP was not correlated with stroke mortality. Multiple regression analysis further identified salt intake as an independent factor to increase stroke mortality, but mean arterial BP was not a determinant. Compared with the four regions with lowest salt intake, odds ratios of stroke mortality adjusted by mean arterial BP were 1.04 (95% CI, 1.03-1.06) for the intermediate four regions and 1.25 (95% CI, 1.23-1.27) for the four regions with highest salt intake. These findings suggest that salt intake may have an adverse effect on stroke mortality independently of BP.
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Affiliation(s)
- Tatsuya Tomonari
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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De Mello WC, Frohlich ED. On the local cardiac renin angiotensin system. Basic and clinical implications. Peptides 2011; 32:1774-9. [PMID: 21729730 DOI: 10.1016/j.peptides.2011.06.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 06/20/2011] [Accepted: 06/20/2011] [Indexed: 12/20/2022]
Abstract
In the present review we reevaluated the experimental and clinical evidence that there is a local renin angiotensin system in the heart as well as the presence of a functional intracrine component which is activated during pathological conditions like heart failure and hypertension. The implications of these findings for cardiology were discussed. The novel finding that cell swelling impairs cell coupling and impulse propagation through activation of ionic channels with consequent generation of cardiac arrhythmias and the evidence that AT1 receptors are mechanosensors able to alter the heart function independently of Ang II were discussed. Particular attention was given to the role of salt loading on the activation of a local cardiac renin angiotensin and its consequences.
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Susic D, Frohlich ED. Hypertensive Cardiovascular and Renal Disease and Target Organ Damage: Lessons from Animal Models. Cardiorenal Med 2011; 1:139-146. [PMID: 22258536 PMCID: PMC3130985 DOI: 10.1159/000329334] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This brief review discusses some aspects of hypertensive damage to the kidneys and cardiovascular system. A comparison of renal and cardiac manifestations of hypertensive disease between results of clinical and experimental studies was made, with a major focus on the possible role of salt and the renin-angiotensin system (RAS) in inducing target organ damage. Thus, some degree of renal impairment is often present in patients with essential hypertension, varying from microalbuminuria to end-stage renal disease, whereas in rats with spontaneous hypertension only slight renal damage is seen in old rats with little evidence of renal failure. Since renal damage in hypertensive rats is induced when they are exposed to increased salt intake, we suggested that salt may also account for kidney injury in hypertensive patients. Similarly, cardiac damage is aggravated in hypertensive human beings and rats when given salt excess. We further presented evidence that the RAS may mediate adverse cardiac and renal effects of excessive salt intake. Finally, we also discussed some aspects of the cardiovascular physiology in the giraffe, the only mammal that in comparison with the human being has extremely high pressure at the level of the heart and kidneys but no target organ damage.
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Affiliation(s)
- Dinko Susic
- Hypertension Research Laboratory, Ochsner Clinic Foundation, New Orleans, La., USA
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Endogenous ouabain and the renin-angiotensin-aldosterone system: distinct effects on Na handling and blood pressure in human hypertension. J Hypertens 2011; 29:349-56. [PMID: 20842047 DOI: 10.1097/hjh.0b013e32833ea821] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether the renin-angiotensin-aldosterone system (RAAS) and endogenous ouabain system differently affect renal Na handling and blood pressure. METHODS Three hundred and one patients in whom we compared blood pressure, and renal Na tubular reabsorption in the basal condition and 2 h (T120) after saline infusion. RESULTS Following multivariate-adjusted linear and quartiles analysis, baseline mean blood pressure (MBP) was significantly higher (113.7 ± 1.33 mmHg) in the fourth versus the first endogenous ouabain quartile (103.8 ± 1.04 mmHg) and the trend across the quartiles was highly significant (β = 0.23, P = 3.53e-04). In contrast, an inverse relationship was present in the renin activity (PRA) quartiles with MBP highest in the first (112.5 ± 1.26) and lowest in the fourth PRA quartile (107.6 ± 1.48, P = 0.039). Following an acute saline load, changes in MBP and the slope of the pressure-natriuresis relationship were inversely related across the PRA quartiles. The fractional excretion of sodium (FENa) showed a negative linear trend going from the first to the third endogenous ouabain quartiles (2.35 ± 0.17 and 1.90 ± 0.14%, P = 0.05). Patients in the fourth endogenous ouabain quartile (>323 pmol/l) showed increased FENa T120 (2.78 ± 0.18%, P < 0.01) and increased Na tubular rejection fraction (P = 0.007) after Na load. After the saline load, there was a biphasic relationship between plasma endogenous ouabain and FENa favoring Na retention at low endogenous ouabain and Na excretion at high endogenous ouabain levels. CONCLUSION The RAAS and endogenous ouabain system are two independent and complementary systems having an inverse (RAAS) or a direct (endogenous ouabain system) relationship with hemodynamic parameters.
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Gao F, Han ZQ, Zhou X, Shi R, Dong Y, Jiang TM, Li YM. High Salt Intake Accelerated Cardiac Remodeling in Spontaneously Hypertensive Rats: Time Window of Left Ventricular Functional Transition and Its Relation to Salt-Loading Doses. Clin Exp Hypertens 2011; 33:492-9. [DOI: 10.3109/10641963.2010.551795] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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