Impaired Sodium Excretion During Mental Stress in Mild Essential Hypertension

Schneider, Markus P.; Klingbeil, Arnfried U.; Schlaich, Markus P.; Langenfeld, Matthias; Veelken, Roland; Schmieder, Roland E.

doi:10.1161/01.hyp.37.3.923

Cited by 27 publications

(14 citation statements)

References 22 publications

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“…These findings are consistent with the well-established relationship between obesity and the renin-angiotensin system. 13,14,20 These results are also consistent with a study by Schneider et al 21 on stress-induced pressure natriuresis. This was a double-blind, randomized, crossover study that examined the mechanisms related to impaired sodium regulation in 66 normotensive subjects (half of them with a family history of HTN) and 36 subjects with mild HTN.…”

Section: Discussionsupporting

confidence: 92%

Adiposity Is Related to Gender Differences in Impaired Stress-Induced Pressure Natriuresis

et al. 2003

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Abstract-The purpose of this study was to determine if there are gender differences in stress-induced pressure natriuresis and to examine the effects of adiposity on these differences. The subjects were 151 boys and 141 girls 15 to 18 years of age who underwent a 5-hour stress protocol (2-hour prestress, 1-hour stress, 2-hour poststress) after being brought into similar levels of sodium balance. The gender-by-condition interaction was significant for systolic and diastolic blood pressure (Pϭ0.001 for both), and the effect of condition was significant for sodium excretion (Pϭ0.001). Key Words: gender Ⅲ obesity Ⅲ stress Ⅲ sodium Ⅲ blood pressure Ⅲ natriuresis Ⅲ hypertension, sodium-dependent W e hypothesized 1 that impaired stress-induced pressure natriuresis contributes to the development of essential hypertension (HTN) and blood pressure (BP)-related target organ damage by increasing the cardiovascular load experienced as a result of the stress. Our definition of impaired stress-induced pressure natriuresis is an increase in BP during an extended period of stress without an adequate compensatory increase in urinary sodium excretion (U Na V). We provided indirect support for our hypothesis in a recent study 1 in which black compared with white youths had slower natriuresis across a series of stressors. This pattern was associated with cardiac remodeling. We provided additional support for our hypothesis in another recent study 2 that demonstrated that a significant percentage of black youths showed impaired stress-induced pressure natriuresis during an extended stress period, with BP remaining elevated as long as 2 hours after the cessation of the stressor. Subsequently, we reported 3 that obese compared with lean youths had slower natriuresis during an extended stress period despite similar levels of BP.The well-documented gender differences in cardiovascular disease and HTN have received increased attention in recent years (for recent reviews, see References 4 through 7) 4 -7 . Furthermore, gender differences in cardiovascular responses to acute stress have long been recognized. 8,9 The first goal of this study was to determine if there are gender differences in changes in BP and U Na V during extended stress. A second goal was to determine if these differences are related to adiposity. A final goal was to examine the roles of angiotensin (Ang) II and insulin on the response patterns in a subgroup of boys and girls. Methods Study PopulationThe protocol was approved by the Human Assurance Committee of the Medical College of Georgia. Written informed parental consent and subject assent were obtained before testing. The subject characteristics are provided in ProtocolOur protocol has been described previously in detail. 2,3 Briefly, the subjects were placed on a controlled sodium diet of 4000Ϯ200 mg/d for 3 days before testing. 10 On the fourth day, the subjects performed the stress protocol. The stress protocol included a pretest period of 2 hours, during which the subjects watched movies and/or listened to

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Section: Discussionsupporting

confidence: 92%

Adiposity Is Related to Gender Differences in Impaired Stress-Induced Pressure Natriuresis

et al. 2003

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“…Consistent with this work are studies that reported stress-induced sodium retention in hypertensive patients [10, 25,26] or those with a family history of HTN [6,12]. Furthermore, antihypertensive agents have been shown to correct the abnormality [8,9,25]. The third line consists of studies indicating that sodium retention during stress is related to target-organ changes to the heart, kidney, and vasculature.…”

Section: Clinical Signifi Cance Of Sodium Retention During Stresssupporting

confidence: 60%

“…The most direct evidence comes from animal studies indicating that sodium retention during stress hastens the development of HTN, particularly in those at genetic risk [17][18][19][20][21][22][23][24]. Consistent with this work are studies that reported stress-induced sodium retention in hypertensive patients [10, 25,26] or those with a family history of HTN [6,12]. Furthermore, antihypertensive agents have been shown to correct the abnormality [8,9,25].…”

Section: Clinical Signifi Cance Of Sodium Retention During Stressmentioning

confidence: 74%

Stress-induced sodium retention and hypertension: A review and hypothesis

Harshfield

Dong²,

Kapuku³

et al. 2009

Current Science Inc

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Hypertension--an important health problem in industrialized nations--is particularly significant in blacks and obese individuals, in whom it is hypothesized to result from impaired renal sodium regulation. We reviewed studies that identified individuals with impaired sodium regulation by examining the natriuretic response to mental stress. A significant percentage of black and obese individuals retain or have a diminished natriuretic response to mental stress despite increased blood pressure (BP). This contributes a volume component to the normal resistance-mediated BP increase, and BP remains elevated after the stressor ceases until the volume expansion diminishes. The stress exposes these individuals to greater cardiovascular load. This response pattern has been linked to renin-angiotensin-aldosterone system activity, and is associated with premature target-organ damage. Assessing stress-induced sodium retention provides a method to identify patients with impaired sodium regulation without using a dietary protocol that poses adherence difficulties, or complicated laboratory assessments. Furthermore, research using this technique indicates the effectiveness of renin-angiotensin-aldosterone system blockers in correcting impaired sodium regulation and consequent hypertension in these individuals.

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“…Many researchers have described the involvement of the neuroendocrine, particularly of the sympathetic adrenal medullary mechanisms, in the formation of arterial hypertension in human (Mancia et al 1997, Williams 1997, Sharma et al 1998, DeQuattro & Feng 2002, DiBona 2004. The sympathetic-dependent changes in the kidney function would contribute additionally to the pathogenesis and progression of the hypertensive disease (Schneider et al 2001, Aileru et al 2004, Grisk 2004, Schlaich et al 2004.…”

Section: Discussionmentioning

confidence: 99%

Neuroendocrine profiling in inherited stress-induced arterial hypertension rat strain with stress-sensitive arterial hypertension

Markel¹,

Redina²,

Gilinsky³

et al. 2007

Journal of Endocrinology

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The functions of the hypothalamic adrenal cortical and sympathetic adrenal medullary systems were studied in rats with inherited stress-induced arterial hypertension (ISIAH strain). A characteristic feature of the ISIAH strain is an increase in arterial blood pressure measured both under basal conditions and after restraint stress in particular. In the control ISIAH rats, the basal plasma ACTH concentration was slightly lower than that in the normotensive Wistar albino Glaxo (WAG) rats, and no differences were found in plasma corticosterone. However, the 0 . 5-h restraint stress produced higher activation of the adrenal cortex in the ISIAH rats. Gluco-and mineralocorticoid responses to the blood volume reduction stresses and ACTH and corticosterone responses to social stress were stronger in the ISIAH than in the control WAG rats. An increase in epinephrine content in adrenals in the basal state and enhanced response of the sympathetic adrenal medullary system to handling stress were observed in the ISIAH rats. Restraint stress produced significantly higher expression of genes encoding corticotropinreleasing hormone-mRNA in hypothalamus and proopiomelanocortin-mRNA in pituitary in the ISIAH than in the WAG rats. Restraint stress produced a decrease in glucocorticoid receptor (GR) gene expression (GR-mRNA) in hippocampus in the ISIAH, but not in the WAG rats. A persistent increase in tyrosine hydroxylase-mRNA in adrenals of the ISIAH rats was found. It is concluded that the ISIAH rat strain is an appropriate model of stress-sensitive hypertension with the predominant involvement of the hypothalamic adrenal cortical and sympathetic adrenal medullary systems in its pathogenesis.

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Impaired Sodium Excretion During Mental Stress in Mild Essential Hypertension

Cited by 27 publications

References 22 publications

Adiposity Is Related to Gender Differences in Impaired Stress-Induced Pressure Natriuresis

Adiposity Is Related to Gender Differences in Impaired Stress-Induced Pressure Natriuresis

Stress-induced sodium retention and hypertension: A review and hypothesis

Neuroendocrine profiling in inherited stress-induced arterial hypertension rat strain with stress-sensitive arterial hypertension

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