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Salt Sensitivity, a Determinant of Blood Pressure, Cardiovascular Disease and Survival

Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham

View larger version (21K): [in a new window]   Fig. 1. A) Changes in mean arterial blood pressure in response to saline infusion and sodium and volume depletion in normotensive (white bars) and hypertensive individuals (black bars). B) Changes in mean arterial blood pressure as a function of age in normotensive (white bars) and hypertensive individuals (black bars). C) Changes in mean arterial blood pressure in white male (WM), white female (WF), black male (BM), and black female (BF) individuals in the normotensive and hypertensive groups. Reprinted with permission from Weinberger et al. [14].

View larger version (30K): [in a new window]   Fig. 2. Kaplan-Meier survival curves for normotensive salt-resistant individuals (N+R), normotensive salt-sensitive individuals (N+S), hypertensive salt-resistant individuals (H+R), and hypertensive salt-sensitive individuals (H+S) over the follow-up period. As noted, only the N+R group had an increased survival. Reprinted with permission from Weinberger et al. [19].

View larger version (18K): [in a new window]   Fig. 3. Kaplan-Meier plots of total cardiovascular events by sodium sensitivity. Reprinted with permission from Morimoto et al. [20].

View larger version (18K): [in a new window]   Fig. 4. Pressure-natriuresis curves in the Dietary Approaches to Stop Hypertension (DASH) Diet-Sodium trial. Urinary sodium excretion rate (UNaV: mmol/d) and systemic mean arterial pressure (MAP: mm Hg) were plotted on the ordinate and abscissa for control and DASH diets. Open and closed circles represent data for the control and DASH diets, respectively. Error bars indicate ±1 standard errors of the means. Regression lines for 3 different amounts of sodium were UNaV=30x(MAP-94) in control diet, and UNaV=65x(MAP-93) in DASH diet. DASH diet augmented the slope of the pressure-natriuresis curve from 30 to 65 ([mmol/d]/mm Hg, P=0.0002) without affecting the extrapolated intercept of BP axis (94 vs 93 mm Hg, P=0.22), resulting in a decrease in sodium sensitivity of BP from 0.034 to 0.015 mm Hg/(mmol/d). Please note that the discrepancy between data plot and estimated pressure-natriuresis curve (line) is ascribed to the fact that a regression line was obtained from a whole cluster of data instead of averaging the extrapolated x-intercepts and slopes of the line in each participant. Reprinted with permission from Akita et al. [18].

View larger version (32K): [in a new window]   Fig. 5. Pressure-natriuresis curves in subgroups in the DASH-Sodium trial: A, normotensives versus hypertensives; B, non-African American versus African American; C, age 45 years versus age >45 years; D, nonobese versus obese; and E, male versus female. Open and closed circles represent data for the control and DASH diets, respectively. See legend to Figure 4 for additional explanation. Reprinted with permission from Akita et al. [18].

View larger version (32K): [in a new window]   Fig. 6. Regression analysis of the relation between sodium reduction and change in plasma renin (R) and change in plasma aldosterone (A) where R=0.020 x [sodium reduction] (95% CI, 0.018–0.022), r2=0.43, and P<0.001; A=0.017 x [sodium reduction] (95% CI, 0.015–0.019), r2=0.41, and P<0.001. Reprinted with permission from Graudal et al. [8].

View larger version (43K): [in a new window]   Fig. 7. Changes in systolic BP, plasma renin activity, and urinary sodium excretion from the high-salt to low-salt diet in 34 age- and sex-matched normotensive and hypertensive individuals. * P,0.01, P,0.001 low-salt vs high-salt diet; P,0.05 hypertensives vs normotensives in change in systolic BP and plasma renin activity. Reprinted with permission from He et al. [27].

View larger version (27K): [in a new window]   Fig. 8. Effect of 5 week low (0.05%) and normal (0.55%) salt diets on mean arterial pressure (MAP) of male Nppa+/+ () and Nppa–/– () mice. Results are the mean±SEM. Numbers in parentheses represent the numbers of mice per group. * p<0.05 compared with the respective Nppa+/+ group; p<0.05 compared with the respective normal-salt diet groups. Reprinted with permission from Feng et al. [28].