Salt-resistant and Salt-sensitive Phenotypes Determine the Sensitivity of Blood Pressure to Weight Loss in Overweight/obese Patients

Overview

Journal J Clin Hypertens (Greenwich)

Specialty Cardiology & Vascular Diseases

Date 2008 May 6

PMID 18453794

Citations 5

Authors

Irene S Hoffmann

Anna B Alfieri

Luigi X Cubeddu

Affiliations

Soon will be listed here.

Abstract

High blood pressure (BP) is extremely common in persons with obesity. However, not all obese individuals have high BP, nor does weight loss lower BP in all persons. In this study, the authors investigated whether the salt-sensitive (SS) or salt-resistant (SR) phenotype determines the degree of BP lowering induced by weight loss in a group of middle-aged individuals of whom 80% are of Hispanic descent. Overweight/obese participants classified as SS or SR (N=45; body mass index, 27-35 kg/m(2)) entered a 1-year program of dietary restriction, aerobic exercise, and metformin therapy. Comparable reductions in obesity (8%-10%), triglycerides (25%), and fasting insulin concentrations (40%) were observed in SR and SS individuals. In SS patients, the intervention lowered systolic BP/diastolic BP by 8.8/6.1 mm Hg, decreased albuminuria by 63%, and decreased the patient's salt sensitivity. Neither BP nor albuminuria was modified in SR persons by the intervention. In obese SS individuals, salt restriction induced comparable BP lowering as weight reduction. In summary, BP lowering induced by the lifestyle/metformin intervention appears to be determined by the SR/SS phenotype. Weight loss and correction of metabolic abnormalities lowers BP in obese SS persons but not in obese SR persons. Correcting adiposity in SS patients lowers BP by making the BP insensitive to dietary salt. The SR phenotype protects from obesity-induced increases in BP.

Citing Articles

Erythrocyte glycocalyx sensitivity to sodium is associated with salt sensitivity of blood pressure in women but not men.

Masenga S, Hamooya B, Patel K, Kirabo A Front Nutr. 2024; 11:1334853.

PMID: 38524849 PMC: 10957757. DOI: 10.3389/fnut.2024.1334853.

Recent Advances in Understanding Peripheral and Gut Immune Cell-Mediated Salt-Sensitive Hypertension and Nephropathy.

Saleem M, Masenga S, Ishimwe J, Demirci M, Ahmad T, Jamison S Hypertension. 2024; 81(3):436-446.

PMID: 38164753 PMC: 10922672. DOI: 10.1161/HYPERTENSIONAHA.123.22031.

Epigenetics of the blood pressure reactivity to salt: Is the salt sensitive phenotype correctable?.

Cubeddu L Bioimpacts. 2023; 13(5):355-358.

PMID: 37736342 PMC: 10509743. DOI: 10.34172/bi.2023.27552.

Prevalence of obesity and overweight and associated nutritional factors in a population-based Swiss sample: an opportunity to analyze the impact of three different European cultural roots.

Ogna A, Ogna V, Bochud M, Paccaud F, Gabutti L, Burnier M Eur J Nutr. 2013; 53(5):1281-90.

PMID: 24374796 DOI: 10.1007/s00394-013-0643-2.

Association of dietary sodium and potassium intakes with albuminuria in normal-weight, overweight, and obese participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

Aaron K, Campbell R, Judd S, Sanders P, Muntner P Am J Clin Nutr. 2011; 94(4):1071-8.

PMID: 21880845 PMC: 3173025. DOI: 10.3945/ajcn.111.013094.

References

Van Gaal L, Mertens I, De Block C . Mechanisms linking obesity with cardiovascular disease. Nature. 2006; 444(7121):875-80. DOI: 10.1038/nature05487. View

Giner V, Poch E, Bragulat E, Oriola J, Gonzalez D, Coca A . Renin-angiotensin system genetic polymorphisms and salt sensitivity in essential hypertension. Hypertension. 2000; 35(1 Pt 2):512-7. DOI: 10.1161/01.hyp.35.1.512. View

Rocchini A, Key J, Bondie D, Chico R, Moorehead C, Katch V . The effect of weight loss on the sensitivity of blood pressure to sodium in obese adolescents. N Engl J Med. 1989; 321(9):580-5. DOI: 10.1056/NEJM198908313210905. View

Reaven G, Lithell H, Landsberg L . Hypertension and associated metabolic abnormalities--the role of insulin resistance and the sympathoadrenal system. N Engl J Med. 1996; 334(6):374-81. DOI: 10.1056/NEJM199602083340607. View

Carmelli D, Cardon L, Fabsitz R . Clustering of hypertension, diabetes, and obesity in adult male twins: same genes or same environments?. Am J Hum Genet. 1994; 55(3):566-73. PMC: 1918417. View

Licata G, Scaglione R, Corrao S, Ganguzza A, Mazzola G, Arnone S . Heredity and obesity-associated hypertension: impact of hormonal characteristics and left ventricular mass. J Hypertens. 1995; 13(6):611-8. DOI: 10.1097/00004872-199506000-00006. View

Suzuki H, Ikenaga H, Hayashida T, Otsuka K, Kanno Y, Ohno Y . Sodium balance and hypertension in obese and fatty rats. Kidney Int Suppl. 1996; 55:S150-3. View

Knowler W, Barrett-Connor E, Fowler S, Hamman R, Lachin J, Walker E . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346(6):393-403. PMC: 1370926. DOI: 10.1056/NEJMoa012512. View

Rocchini A . Obesity hypertension. Am J Hypertens. 2002; 15(2 Pt 2):50S-52S. DOI: 10.1016/s0895-7061(01)02299-3. View

10.

Douketis J, Sharma A . Obesity and cardiovascular disease: pathogenic mechanisms and potential benefits of weight reduction. Semin Vasc Med. 2005; 5(1):25-33. DOI: 10.1055/s-2005-871739. View

11.

Zhang L, Miyaki K, Araki J, Song Y, Kimura T, Omae K . Interaction of angiotensin I-converting enzyme insertion-deletion polymorphism and daily salt intake influences hypertension in Japanese men. Hypertens Res. 2007; 29(10):751-8. DOI: 10.1291/hypres.29.751. View

12.

Rocchini A . Obesity hypertension, salt sensitivity and insulin resistance. Nutr Metab Cardiovasc Dis. 2001; 10(5):287-94. View

13.

Wisse B . The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol. 2004; 15(11):2792-800. DOI: 10.1097/01.ASN.0000141966.69934.21. View

14.

Cusi D, Barlassina C, Azzani T, Casari G, Citterio L, Devoto M . Polymorphisms of alpha-adducin and salt sensitivity in patients with essential hypertension. Lancet. 1997; 349(9062):1353-7. DOI: 10.1016/S0140-6736(97)01029-5. View

15.

Hoffmann I, Tavares-Mordwinkin R, Castejon A, Alfieri A, Cubeddu L . Endothelial nitric oxide synthase polymorphism, nitric oxide production, salt sensitivity and cardiovascular risk factors in Hispanics. J Hum Hypertens. 2004; 19(3):233-40. DOI: 10.1038/sj.jhh.1001801. View

16.

Ratner R, Goldberg R, Haffner S, Marcovina S, Orchard T, Fowler S . Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Diabetes Care. 2005; 28(4):888-94. PMC: 1307521. DOI: 10.2337/diacare.28.4.888. View

17.

Fuenmayor N, Moreira E, Cubeddu L . Salt sensitivity is associated with insulin resistance in essential hypertension. Am J Hypertens. 1998; 11(4 Pt 1):397-402. DOI: 10.1016/s0895-7061(97)00490-1. View

18.

Cirillo M, Lombardi C, Bilancio G, Chiricone D, Stellato D, De Santo N . Urinary albumin and cardiovascular profile in the middle-aged population. Semin Nephrol. 2005; 25(6):367-71. DOI: 10.1016/j.semnephrol.2005.05.004. View

19.

Vitale C, Mercuro G, Cornoldi A, Fini M, Volterrani M, Rosano G . Metformin improves endothelial function in patients with metabolic syndrome. J Intern Med. 2005; 258(3):250-6. DOI: 10.1111/j.1365-2796.2005.01531.x. View

20.

Beeks E, Kessels A, Kroon A, van der Klauw M, de Leeuw P . Genetic predisposition to salt-sensitivity: a systematic review. J Hypertens. 2004; 22(7):1243-9. DOI: 10.1097/01.hjh.0000125443.28861.0d. View