Reports of elevated plasma catecholamine levels and augmented responses to autonomic blockade suggest increased sympathetic tone in borderline hypertension. It is not known if this reflects greater sympathetic neural outflow. We directly recorded muscle sympathetic nerve activity (microneurography) in 15 normotensive and 12 borderline hypertensive age-matched men to determine whether borderline hypertensive individuals have elevated sympathetic nerve activity. Supine heart rate, blood pressure, plasma norepinephrine, and efferent muscle sympathetic nerve activity (peroneal nerve) were measured after 6 days of both low and high dietary sodium intake (10 and 400 meq sodium/24 hr). Sympathetic nerve activity was elevated significantly in borderline hypertensive individuals on both low (37 ±1 in borderline hypertensive individuals vs. 29±1 bursts/min in normotensive individuals; p<0.01) and high (25+1 in borderline hypertensive individuals vs. 16±1 bursts/min in normotensive individuals; p<0.01) sodium diets. The borderline hypertensive group had higher systolic (p<0.01) and diastolic (/?<0.05) blood pressures independent of sodium intake. Across both groups, high sodium intake reduced muscle sympathetic nerve activity (p<0.001), plasma norepinephrine (/»<0.001), diastolic blood pressure (p<0.02), heart rate (/?< 0.002), and increased weight (p<0.005). A significant (p<0.05) group-by-diet interaction was observed for plasma norepinephrine levels. Specifically, compared with the normotensive group, plasma norepinephrine levels in the borderline hypertensive group tended to be higher on low sodium diet (p=0.08) and lower on high sodium diet (/?=0.23). High sodium intake increased diastolic pressure by over 5 mm Hg in six of 27 subjects (four borderline hypertensive and two normotensive). Sympathetic activity in sodium-sensitive subjects was not elevated compared with sodium-resistant subjects and also declined during high sodium intake. This study supports the hypothesis of elevated central sympathetic neural outflow in borderline hypertension. (Hypertension 1989;14:177-183) I ncreasing evidence suggests that mild or borderline hypertension is characterized by augmented sympathetic activity both at rest and in response to physical and psychological stressors.1 -5 For example, Esler et al 6 found elevated plasma norepinephrine levels (compared with This manuscript from the University of Iowa was sent to Randall M. Zusman, Consulting Editor, for review by expert referees, for editorial decision, and final disposition.Address for correspondence: Dr. Erling A. Anderson, Department of Anesthesia, University of Iowa, College of Medicine, Iowa City, IA 52242.Received August 12, 1988; accepted March 22, 1989. normotensive persons) in younger, but not older, hypertensive humans. Goldstein 7 reviewed studies of plasma catecholamine levels in hypertension and noted that significant elevations were reported in 11 of 16 studies comparing young (less than 40 years) hypertensive individuals with normotensive individuals but in...

The present study examined the role of personality as a predictor of mortality among patients with chronic renal insufficiency. A prospective evaluation of the influence of personality on patient survival was conducted over an average 49-month period. Cox regression was used to evaluate the effects of 5 dimensions of personality in a sample of 174 patients (100 male and 74 female). At follow-up, 49 patients had died. Significant demographic and clinical predictors of survival included age, diabetic status, and hemoglobin level. After these predictors were controlled for, 2 personality traits, conscientiousness and neuroticism, predicted patient mortality. Patients with high neuroticism scores had a 37.5% higher estimated mortality rate. Patients with low conscientiousness scores had a 36.4% increased mortality rate.

Among end-stage renal disease (ESRD) patients on hemodialysis, death from withdrawal from life-sustaining dialysis is increasingly common. The present study's objective was to examine depression as a potential risk factor for hemodialysis withdrawal. Two hundred forty ESRD hemodialysis (133 male and 107 female) patients were followed for an average of 4 years after depression symptom assessment. Of these, 18% withdrew from dialysis. Using multivariate survival analysis and after controlling for the effects of age (p < .001) and clinical variables, the authors found that level of depression symptoms was a unique and significant predictive risk factor for the subsequent decision to withdraw from dialysis (p < .05). The potential impact that depression may have on the decision to withdraw from hemodialysis should be considered by health care providers, patient families, and patients.

The present study found that participation in a behavioral self-regulation intervention resulted in no unique intervention effect on a key indicator of adherence for those with severe chronic kidney disease. There was, however, modest within-subjects improvement in interdialytic weight gain for the intervention group which meshes with other evidence showing the utility of behavioral interventions in this patient population. ClinicalTrials.gov Identifier: NCT01066949.

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