Sodium sensitivity of blood pressure in Chinese populations

Abstract

Hypertension is an enormous public-health challenge in the world due to its high prevalence and consequent increased cardiovascular disease morbidity and mortality. Observational epidemiologic studies and clinical trials have demonstrated a causal relationship between sodium intake and elevated blood pressure (BP). However, BP changes in response to sodium intervention vary among individualsa trait called sodium sensitivity. This paper aims to review the recent advances in sodium-sensitivity research in Chinese and other populations. Older age, female gender, and black race are associated with high sodium sensitivity. Both genetic and environmental factors influence BP sodium sensitivity. Physical activity and dietary potassium intake are associated with reduced sodium sensitivity while obesity, metabolic syndrome and elevated BP are associated with increased sodium sensitivity. Familial studies have documented a moderate heritability of sodium sensitivity. Candidate gene association studies, genome-wide association studies, whole-exome, and whole-genome sequencing studies have been conducted to elucidate the genomic mechanisms of sodium sensitivity. The Genetic Epidemiology Network of Salt Sensitivity (GenSalt) study, the largest family-based feeding study to date, was conducted among 1906 Han Chinese in rural northern China. This study showed that approximately 32.4% of Chinese adults were sodium sensitive. Additionally, several genetic variants were found to be associated with sodium sensitivity. Findings from the GenSalt Study and others indicate that sodium sensitivity is a reproducible trait and both lifestyle factors and genetic variants play a role in this complex trait. Discovering biomarkers and underlying mechanisms for sodium sensitivity will help to develop individualized intervention strategies for hypertension.

From salt to hypertension, what is missed?

“… 24 , 25 , 26 The frequency of BP salt sensitivity is 32–64% in hypertensives and up to 50% in normotensives. 27 The salt sensitivity of BP is derived by the interaction among heredity, comorbidities and environment. 27 Genetic variants related to the salt sensitivity of BP involve several biological pathways linked to hypertension, such as the renin angiotensin aldosterone system (RAAS), sympathetic nervous system, ion and water channels, transporters and exchangers, endothelial system, intracellular messengers and the natriuretic peptide system.…”

Angiotensin receptor neprilysin inhibitor as a novel antihypertensive drug: Evidence from Asia and around the globe

“…It is well known that Asians have higher salt intake than other parts of the world 10 . Salt sensitivity is defined by an increase in blood pressure after sodium loading 11 . Of note, the anion for sodium is poorly defined in the conventional definition of salt sensitivity.…”

Candidate Gene Polymorphisms Influence the Susceptibility to Salt Sensitivity of Blood Pressure in a Han Chinese Population: Risk Factors as Mediators

“…Salt sensitivity of blood pressure (SSBP) is defined as a quantitative trait in which the BP of some members of the population displays changes that are parallel to changes in sodium ingestion ( Elijovich et al, 2016 ). The Genetic Epidemiology Network of Salt Sensitivity (GenSalt) study reported that the prevalence of salt sensitivity (SS), which is defined as a qualitative trait of SSBP, is approximately 34.2% among Chinese adults ( Liu et al, 2020 ). SSBP not only plays a role in the pathogenesis of hypertension but is also a risk factor for cardiovascular complications that increase mortality.…”

“…Genes can be involved in SSBP pathology through various pathways (the renin-angiotensin-aldosterone system, ion and water channels, transporters and exchangers, the endothelial system, the apelin–APJ system, the sympathetic nervous system, intracellular messengers, and the kallikrein-kinin system) ( Liu et al, 2020 ). Several genome-wide association studies (GWAS) and candidate gene studies have been conducted for SSBP, and the results were reviewed ( Liu et al, 2020 ). Two GWAS have been conducted on SSBP subjects identified by acute salt loading and a chronic sodium diet ( Citterio et al, 2011 ; Li et al, 2016 ).…”

“…Moreover, SNPs and SSBP have a non-linear relationship, and potential risk factors may modulate the effects of SNPs on SSBP. The evidence has shown that several risk factors, including obesity, hyperglycemia, and dyslipidemia, are strongly associated with SSBP ( Chen et al, 2009 ; Liu et al, 2020 ). Of note, several genes have been identified that are related to the above risk factors, which overlap with the genes associated with SSBP ( Yazdanpanah et al, 2007 ; Ochoa et al, 2008 ; Niemiec et al, 2011 ; Ding et al, 2018 ).…”