Abstract
BackgroundAge-related alterations in renal sodium handling affect blood pressure (BP). We aimed to clarify whether the pressure-natriuresis response changes with age, leading to BP elevation.MethodsA total of 4,859 participants with normal renal function from the Korean Genome and Epidemiology Study (KoGES) and 235 patients with non-diabetic chronic kidney disease (CKD) from the ESPECIAL trial were included and divided into the younger and older groups. In ESPECIAL, participants took olmesartan from weeks 0 to 16 and were educated about a low-salt diet (LSD) from weeks 8 to 16.ResultsIn both studies, older participants showed lower estimated glomerular filtration rate (eGFR) and urine concentration index and higher albuminuria. In KoGES, BP was higher and urine sodium was lower in older participants. In ESPECIAL, diastolic BP at 0 week was lower in older participants. Olmesartan reduced BP in both groups, whereas LSD decreased systolic BP only in older participants. Urine sodium increased in younger participants but decreased in older participants after olmesartan use. In KoGES, urine sodium was correlated with BP in both groups after adjusting for age, sex, and eGFR; however, the correlation coefficient was lower in older participants. In ESPECIAL, only younger participants showed a significant positive association between systolic BP and urine sodium in multiple regression analysis.ConclusionsThe pressure-natriuresis response was diminished in older participants with or without CKD.
Highlights
The prevalence of hypertension is reported to be >75% in adults aged >65 years, and hypertensionrelated complications increase with age [1]
Pressure-Natriuresis Response Was Decreased in the Older Group in Korean Genome and Epidemiology Study (KoGES)
Sodium intake did not differ between the two age groups, whereas urine sodium excretion tended to be lower in the older group (p = 0.073) (Figures 1C,D)
Summary
The prevalence of hypertension is reported to be >75% in adults aged >65 years, and hypertensionrelated complications increase with age [1]. Pressure-Natriuresis in Old Age in animal and human studies. Old rats were observed to excrete less sodium during acute volume expansion or in response to angiotensin II (ANGII) infusion than young rats [5, 6]. In human studies, participants older than 40 years excreted less sodium after normal saline loading than those younger than 40 years [8]. The average BP increased with age, and the incidence of salt-sensitive hypertension was higher in individuals with advanced age than in those with younger age [9]. Agerelated decline in sodium excretion and a shift to the right of the pressure-natriuresis curve may be the main causes of increased salt-sensitive hypertension in the older population. Age-related alterations in renal sodium handling affect blood pressure (BP). We aimed to clarify whether the pressure-natriuresis response changes with age, leading to BP elevation
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