Fixed Sodium Intake Research Articles

Effect of indomethacin on the renal response to angiotensin II receptor blockade in healthy subjects

Non-steroidal anti-inflammatory drugs are known to promote sodium retention and to blunt the blood pressure lowering effects of several classes of antihypertensive agents including beta-blockers, diuretics and angiotensin converting enzyme (ACE) inhibitors. The purpose of the present study was to investigate the acute and sustained effects of indomethacin on the renal response to the angiotensin II receptor antagonist valsartan and to the ACE inhibitor enalapril. Twenty normotensive subjects maintained on fixed sodium intake (100 mmol sodium/day) were randomized to receive for one week: valsartan 80 mg o.d., enalapril 20 mg o.d., valsartan 80 mg o.d. + indomethacin 50 mg bid and enalapril 20 mg o.d. + indomethacin 50 mg bid. This single-blind study was designed as a parallel (valsartan vs. enalapril) and cross-over trial (valsartan or enalapril vs. valsartan + indomethacin or enalapril + indomethacin). Renal hemodynamics and urinary electrolyte excretion were measured for six hours after the first and seventh administration of each treatment regimen. The results show that valsartan and enalapril have comparable renal effects characterized by no change in glomerular filtration rate and significant increases in renal plasma flow and sodium excretion. The valsartan- and enalapril-induced renal vasodilation is not significantly blunted by indomethacin. However, indomethacin similarly abolishes the natriuresis induced by the angiotensin II antagonist and the ACE inhibitor. This observation suggests that although angiotensin receptor antagonists do not affect prostaglandin metabolism, the administration of a non-steroidal anti-inflammatory drug blunts the natriuretic response to angiotensin receptor blockade.

AT1 and TxA2/PGH2 receptors maintain hypertension throughout 2K,1C Goldblatt hypertension in the rat.

Angiotension II (ANG II) increases the generation of vasoconstrictor prostaglandin endoperoxides (PGH2) and thromboxane A2 (TxA2). Two-kidney, one-clip (2K,1C) Goldblatt hypertensive rats have an increased plasma renin activity (PRA) and ANG II level during the early, but not the late, phases of hypertension. Therefore, the aim of these studies was to compare the antihypertensive efficacy of an ANG II type I (AT1) and a TxA2/PGH2 receptor antagonist during different phases of 2K,1C hypertension. Rats were maintained on a fixed sodium intake for 3 days before and throughout the period of drug administration. These studies assessed the antihypertensive response to administration of the AT1 receptor antagonist losartan (20 mg.kg-1.day-1), the TxA2/PGH2 receptor antagonist ifetroban (20 mg.kg-1.day-1) or vehicle given for 3 days to rats with early (2-4 wk postclip), intermediate (10-12 wk postclip), and late (36-42 wk post-clip) 2K,1C hypertension and to two control groups of rats corresponding in age to the early or intermediate and the late 2K,1C groups. The mean arterial pressure (MAP) was measured directly with indwelling arterial cannulas. The MAP of sham-operated rats was 109 +/- 5 mmHg. In the early phase of 2K,1C hypertension, the MAP was increased to 143 +/- 6 mmHg, and it was increased further to 162 +/- 5 mmHg during the intermediate and to 179 +/- 4 mmHg during the late phase. The PRA, compared with age-matched controls, was increased during early and intermediate, but not late phase 2K,1C hypertension. Neither drug lowered blood pressure in control rats. However, both drugs significantly reduced the blood pressure in the early, intermediate, and late phases of 2K, 1C hypertension. At the end of 3 days of administration, blood pressure in early 2K, 1C rats given losartan was reduced to levels of control rats, but remained slightly elevated in other groups and in those receiving ifetroban. In conclusion, AT1 and TxA2/PGH2 receptors maintain hypertension throughout the evolution of 2K, 1C hypertension in the rat, despite changes in PRA.

Comparison Between Chronic Converting Enzyme Inhibition and AT1 Blockade in mRen2 Transgenic Rats

We compared the consequences of chronic angiotensin-converting enzyme (ACE) inhibition with quinapril and of specific AT1 blockade with losartan in a renin-dependent model of hypertension, the (mRen2)27 transgenic rats (TG). Animals were orally treated with 10 mg/kg/24 h of either quinapril (TGQ, n = 13) or losartan (TGL, n = 12) from age 4 to age 9 weeks. Indirect systolic blood pressure (SBP), and sodium and water balances were measured for 3 consecutive weeks. Nine-week-old rats were instrumented to record aortic BP in the conscious state. In addition, they received an infusion of glucose and saline to increase their diuresis and thus allow accurate assessment of their renal excretion during short time periods. These rats were studied for three one-h periods: (a) baseline, (b) after the administration of a bradykinin (BK) antagonist, and (c) after a cross-treatment; i.e., TGQ rats receiving losartan (10 mg/kg intravenously, i.v.) and TGL rats receiving quinapril (10 mg/kg i.v.). TGL rats differed from TGQ rats by an unconsistently lower indirect SBP associated with significantly lower urinary volume and sodium excretion, whereas the sodium balance did not differ between the two groups. In conditions of fixed sodium intake the aortic BP of TGQ rats was still nonsignificantly different from that of TGL rats, and TGQ rats also exhibited two-fold higher natriuresis. The BK antagonist had no effect in either group, whereas losartan decreased the BP of TGQ rats. We conclude that in TG rats ACE inhibition is associated with an increased natriuresis as compared with specific AT1 blockade, an effect that is independent of the sodium intake. Because a BK antagonist had no effect, such a difference might be due to an antinatriuretic effect of AT2 receptors in chronic conditions.

Relationship between sodium balance and renal innervation during hypertension development in the spontaneously hypertensive rat

The spontaneously hypertensive rat (SHR) has been shown to possess elevated efferent sympathetic nerve activity, and renal denervation delays the development of hypertension in this genetic strain. Evidence that the renal sympathetic nerves have direct effects on tubular function suggests that one of the mechanisms for increasing arterial pressure in the SHR might involve neurally mediated sodium retention. The present study examined the relationships between renal sympathetic tone, daily sodium balance and the development of hypertension in SHR over a 4-week period. Conscious, unrestrained, 7-week-old SHR with innervated or denervated kidneys were placed on a fixed sodium intake by intravenous infusion (5.72 mumol/day per 100 g body weight). Urinary sodium excretion was determined once a day for 28 consecutive days; systolic blood pressure (SBP) and body weight were monitored twice a week. Renal denervation delayed the onset of and retarded the development of hypertension. Despite the difference in SBP, daily sodium balance was equal in the innervated and the denervated SHR. The positive sodium balances exhibited by both groups are attributed to the rapid growth observed during the time course of the experiment. The growth rate was also similar in the two groups. The present data indicate that, although the renal nerves may mediate enhanced transient tubular sodium reabsorption, sodium retention does not contribute directly to the development of hypertension in the SHR. Rather, it appears that the elevation of arterial pressure might occur as a requirement to excrete excess sodium and thus maintain a daily sodium balance.

Acute and sustained changes in sodium balance during nifedipine treatment in essential hypertension

purpose: To assess the changes in sodium excretion and sodium balance after initiation of nifedipine treatment and after withdrawal of nifedipine. patients: Eight patients with uncomplicated mild to moderate essential hypertension were entered in a single-blind, placebo-controlled study of 39 days' duration. methods: Two 7-day periods while on a fixed sodium intake of 150 mmol/day approximately 3 weeks apart. After 4 days of a placebo and fixed sodium intake, patients were given nifedipine GITS (gastrointestinal therapeutic system) once a day and carefully studied for the following 4 days. Thereafter, patients continued to receive nifedipine GITS, and approximately 3 weeks later they were studied again for a week while on a fixed sodium intake. Nifedipine administration was stopped and changes occurring after withdrawal were studied. results: Nifedipine caused a significant increase in sodium excretion with a cumulative loss of sodium of 38 mmol per subject within the first 4 days of treatment. The withdrawal of nifedipine treatment caused a significant decrease in sodium excretion and a cumulative retention of sodium of 42 mmol per subject within the first 4 days of withdrawal. conclusions: Nifedipine causes an acute and a sustained reduction in sodium balance in patients with essential hypertension. This prolonged effect may contribute to the mechanism whereby nifedipine lowers blood pressure.

Neurogenic regulation of rate of achieving sodium balance after increasing sodium intake

Evidence that the renal sympathetic nerves have direct effects on renal tubular function suggests that neurogenic mechanisms may play an important role in the daily regulation of sodium balance. We evaluated the influence of the renal nerves on the rate of elevating urinary sodium excretion (UNaV) after a step increase in fixed sodium intake. Conscious rats with innervated (INN) or denervated (DNX) kidneys were placed on low-sodium intake (LNa = 0.3 meq/day) or a normal sodium intake (NNa = 1.0 meq/day) by intravenous infusion. Hourly changes in UNaV were determined 24 h before and 72 h after increasing sodium intake to either NNa or high-sodium intake (HNa = 5.0 meq/day). Switching from LNa to NNa, INN rats increased UNaV within 24 h; however, DNX rats did not begin to increase UNaV until hour 60. Cumulative sodium balance over 72 h was more positive in DNX rats (INN = 1.29 +/- 0.29 meq; DNX = 2.06 +/- 0.21 meq, P less than 0.05). During the LNa-to-HNa switch, both INN and DNX rats increased UNaV equally for 12 h; however, at this time INN rats continued to increase UNaV, whereas DNX rats did not. DNX rats had a net accumulation of 2.54 meq more sodium than INN rats over 72 h. Significant inhibition of plasma renin activity within the first 24 h occurred only in rats receiving the LNa-to-HNa switch in sodium intake, and this response was not different between rats with innervated and denervated kidneys. These data suggest that the renal nerves provide a rapid sodium excretory response to step increases in sodium intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Lack of effect of dietary potassium on renal lithium clearance in man

The effects of alterations in dietary potassium (40, 80 and 160 mmol day-1) on endocrine status and on renal lithium clearance were assessed in 10 healthy subjects on a fixed sodium intake; measurements were made on the fifth day of each dietary regimen. Plasma aldosterone concentration was found to increase with potassium intake, whereas plasma renin activity and the plasma concentration of atrial natriuretic peptide did not change significantly. Neither absolute lithium clearance nor fractional lithium excretion was affected measurably by changes in dietary potassium, suggesting that provided the potassium intake remains within the normal range it is unnecessary to control this factor during lithium clearance studies in man.

Regulation of cardiac output during aldosterone-induced hypertension.

The classical haemodynamic transients of volume-loading hypertension have been difficult to demonstrate in aldosterone-induced hypertension. Because recent studies have shown that continuous whole-day measurements of cardiac output are superior to short-term recordings, we studied the transient haemodynamic effects of aldosterone-induced hypertension while monitoring arterial pressure and cardiac output (electromagnetic flow probe) continuously for 20 h a day. In six dogs maintained on a fixed sodium intake of 150 mmol/day, we infused aldosterone (12 micrograms/kg per day, intravenously) for 10 days. The aldosterone induced a progressive increase in mean arterial pressure, from a control value of 88 +/- 1 to 107 +/- 2 mmHg. Cardiac output increased progressively, reaching a peak average value on the 4th day of infusion of +14 +/- 5% above control, and remained slightly elevated throughout the infusion period. Total peripheral resistance increased slowly to a value averaging +13 +/- 4% above control. Therefore, our experiments show that aldosterone induces a primary increase in cardiac output followed by a secondary vasoconstriction, which is consistent with the classical transient haemodynamic effects of volume-loading hypertension.

Elevated levels of atrial natriuretic peptide during aldosterone escape.

Escape from the sodium-retaining effects of aldosterone (ALDO) is thought to occur as a result of natriuretic compensatory mechanisms triggered by extracellular fluid volume expansion. The purpose of the present study was to determine whether increases in plasma levels of atrial natriuretic peptide occur during ALDO escape in conscious dogs (n = 6) maintained on a fixed sodium intake (60 meq/day). Infusion of ALDO at a rate of 15 micrograms X kg-1 X day-1 for 6 days decreased sodium excretion (UNaV) from 59.1 +/- 4.0 to 36.2 +/- 5.7 meq/day on day 1, and then UNaV gradually returned to control levels by day 5 of ALDO infusion. Net cumulative sodium balance progressively increased during ALDO infusion, reaching a peak value of 88.8 +/- 21.3 meq/day on day 5. Mean arterial pressure increased from 85 +/- 3 to 95 +/- 4 mmHg, and plasma renin activity decreased from 1.32 +/- 0.27 to 0.32 +/- 0.07 ng angiotensin (ANG) I X ml-1 X h-1 during ALDO infusion. Plasma levels of atrial natriuretic peptide averaged 67.5 +/- 8.9 pg/ml during control and increased to a peak value of 120 +/- 18 pg/ml by day 4 of ALDO infusion. Three to four days after ALDO infusion was stopped, plasma levels of atrial natriuretic peptide averaged 46 +/- 5 and 50 +/- 6 pg/ml, respectively. In summary, escape from the sodium-retaining effects of ALDO is associated with significant increases in the circulatory levels of atrial natriuretic peptide.

Changes in the plasma levels of atrial natriuretic peptides during mineralocorticoid escape in man.

Plasma levels of atrial natriuretic peptide (ANP) were measured by radioimmunoassay in eight normal healthy volunteers before and during mineralocorticoid escape. Mean plasma ANP on a fixed sodium intake before fludrocortisone was 6.5 +/- SEM 1.1 pg/ml. Within 24 h of fludrocortisone administration there was a significant increase in plasma ANP which continued to increase daily reaching a plateau by day 4 (14.9 +/- 2.4 pg/ml) to day 7 (15.1 +/- 2.6 pg/ml). The rise in plasma ANP was closely related to the amount of sodium retained during the fludrocortisone treatment and the sodium 'escape' occurred by days 4 to 7. These results support the concept that ANP could play an important hormonal role in over-coming the sodium-retaining effects of mineralocorticoids in man.

Nifedipine, sodium intake, diuretics, and sodium balance.

The acute blood pressure-lowering effect of nifedipine was studied in patients on high, normal, and low sodium diets. The demonstrated decrease in blood pressure was greatest in those patients receiving the high sodium diet. Studies were then performed with a combination of nifedipine and the diuretic bendrofluazide. When nifedipine was given to patients already on bendrofluazide, there was an additional fall in blood pressure. However, when bendrofluazide was added to the regimen of patients already receiving nifedipine, there was no further reduction in blood pressure. Studies were then performed in patients receiving chronic nifedipine therapy who had their nifedipine treatment stopped while on a fixed sodium intake. All patients retained sodium and there was an increase in weight. This latter study confirms that nifedipine causes a long-term reduction in sodium balance in patients with essential hypertension. It is possible that these long-term changes in sodium balance with nifedipine could partially explain the blunting of the blood pressure-lowering effect seen when the thiazide diuretic was added to the regimen of patients already receiving nifedipine.

Effects of nonsteroidal antiinflammatory drugs on renal function in patients with renal insufficiency and in cirrhotics.

We have assessed the effects of acute and chronic administration of etodolac, ketoprofen, and indomethacin on renal function in patients with mild to moderate chronic renal insufficiency (CRI). We studied 18 normal volunteers and 24 patients with CRI due to hypertension and/or diabetes mellitus with creatinine clearances between 19 and 83 mL/min/1.73 m2. Clearance studies were performed with the first dose of nonsteroidal antiinflammatory drug (NSAID) to compare acute effects of the agent with a no-drug control. Subjects then received the NSAID for three to five days and, on the last day of study, underwent another clearance study to assess the effects of a single dose of NSAID superimposed on chronic dosing. With each dose of each NSAID, inulin and paraaminohippurate (PAH) clearances and fractional excretion of NA+ decreased. However, the baseline control collections after chronic dosing did not differ from the no-drug control periods. Hence, the decline in renal function with each dose is transient, and no overall adverse effect on renal function occurred with chronic dosing. In five patients with cirrhosis, we assessed the renal sparing effects of sulindac. After equilibration on a fixed sodium intake, they received a 200-mg dose of sulindac. In one patient, no adverse effect occurred; the remaining patients suffered declines in creatinine clearance of 29%, 87%, 37%, and 37%, respectively. This effect was transient and returned to control values six to eight hours after sulindac administration. At the time of maximal depression of renal function, serum concentrations of sulindac sulfide were comparable to those in subjects with normal hepatic function.(ABSTRACT TRUNCATED AT 250 WORDS)

EVIDENCE THAT PATIENTS WITH ADDISON'S DISEASE ARE UNDERTREATED WITH FLUDROCORTISONE

Ten patients with Addison's disease, nine with undetectable plasma aldosterone, were found to be sodium and water depleted with high levels of plasma-renin activity despite receiving 0·05-0·1 mg/day of fludrocortisone and optimum doses of glucocorticoid replacement therapy. Fludrocortisone was withdrawn while patients were in hospital on a fixed sodium intake. There was an immediate natriuresis with a further increase in plasma-renin activity. When a daily dose of 0·3 mg offludrocortisone was given all patients retained sodium and water and gained weight. There was a fall in plasma-renin activity in all patients and an associated fall in blood urea and plasma potassium, and an increase in plasma volume; oedema developed in some patients. At outpatient follow-up, the dose of fludrocortisone was adjusted according to plasma-renin activity. Most patients required 0·2 mg of fludrocortisone to maintain adequate sodium and water balance. These results suggest that patients with Addison's disease on 0·05-0·1 mg of fludrocortisone with undetectable plasma aldosterone levels are currently being undertreated with fludrocortisone. The best way of assessing sodium balance in these patients and their response to fludrocortisone is by measurement of plasma-renin activity in conjunction with 24 h urinary sodium excretion.

Prostaglandin E2-induced hypertension in conscious dogs.

The effects of continuous intrarenal prostaglandin E2 (PGE2) infusion (7 days) on sodium and water balance, plasma renin activity (PRA), and sodium and water balance, plasma renin activity (PRA), and mean arterial pressure (MAP) were examined in conscious, unilaterally nephrectomized dogs maintained on a fixed sodium intake of 55 meq/day. PGE2 infusion (2 microgram/min) resulted in a sustained threefold increase in both urine output and water intake without a measurable change in glomerular filtration rate. PRA increased from 0.4 +/- 0.1 during the control period to 2.2 +/- 0.9 ng AI.ml-1.h-1 on day 1 and averaged 3.6 +/- 0.5 for the remaining 6 days of PGE2 infusion. Concurrently, MAP increased from 102 +/- 3 to a maximum of 117 +/- 4 mmHg on day 5; changes in PRA and MAP were significantly correlated (r = 0.96, P less than 0.001). Sodium excretion increased from 54.5 +/- 3 to 88.0 +/- 19 meq/day on day 1, and then declined to an average of 64.8 +/- 1 meq/day for the remaining 6 days of infusion. All variables returned to the control level during the recovery period. Intravenous infusion of PGE2 (2 microgram/min) yielded directionally similar but statistically insignificant effects. It is concluded that chronic intrarenal PGE2 infusion results in marked diuresis, polydipsia, a moderate loss of sodium, enhanced PRA, and mild hypertension.

The influence of different sodium loads on renin release in hypertensive and normotensive states of chronic renal failure.

The purpose of the present study was to examine the influence of different sodium loads on renin release in the hypertensive and normotensive state of chronic renal failure. Blood pressure (BP), plasma renin concentration (PRC) and exchangeable sodium (NaE) were measured in eighteen patients with advanced chronic renal failure, nine hypertensives and nine normotensives, and in seven normal subjects (a) 6 days after a fixed sodium intake of 10 mmol/day, and (b) 6 days after a fixed sodium intake of 150 mmol/day. Mean NaE was 14-19% higher in the hypertensives compared with the normotensives and values of NaE correlated significantly to values of mean BP. No significant differences were present in PRC between the groups of patients and controls on either of the sodium regimens and no correlation was found between BP and PRC. However, average decreases of PRC in the hypertensives on high sodium intake, 33-34%, were significantly lower than the corresponding values of 69-71% in the normotensive patients and controls, respectively. Furthermore, the percentage changes of PRC on high sodium intake correlated significantly to mean BP as well as to NaE. These results suggest that renin release is relatively unresponsive to different sodium intakes in hypertension following chronic renal failure. This alteration in renin release may contribute to the maintenance of hypertension in chronic renal failure, PRC being "inappropriately' increased in relationship to the sodium excess.

Effects of progesterone and four synthetic progestagens on sodium balance and the renin-aldosterone system in man.

ABSTRACT The influence of treatment with progesterone and with 4 synthetic progestagens (megestrol-acetate, dydrogesterone, norethisterone-acetate, d-norgestrel) for 6 days on sodium balance and on different factors of the renin-aldosterone system was investigated in 20 young healthy men on a fixed sodium intake (83 mEq/day). 50 mg of progesterone im caused, as expected, natriuresis, an increase in plasma renin activity (PRA), plasma angiotensin II concentration (PAC) and aldosterone excretion (AER), while plasma renin substrate concentration (PRS) remained unchanged. Progesterone levels during treatment were somewhat lower than in the luteal phase of normal menstrual cycles in women. Megestrol-acetate (15 mg/day) did not influence sodium balance, but led to a slight increase in PRA and AER after 3 days of treatment. PAC and PRS remained unchanged. Dydrogesterone (30 mg/day) caused slight sodium retention after 3 days of treatment and a concomitant increase in PRA, PAC (upright posture) and AER, but PRS w...

Studies of the control of plasma aldosterone concentration in normal man. II. Effect of dietary potassium and acute potassium infusion.

The responses of plasma aldosterone, cortisol, and corticosterone to an infusion of 75 mEq of potassium chloride over 120 min were studied in 10 normal subjects. Five subjects were fed a 10 mEq and five a 200 mEq sodium diet, while all subjects ingested 40 mEq and 200 mEq potassium sequentially. Two potassium infusions were performed in each subject when in balance on a fixed sodium intake and low and then high potassium diets. Regardless of dietary intake, increases of serum potassium of 0.5-1.5 mEq/liter above preinfusion levels were usually associated with significant increments in plasma aldosterone concentration. Our data agree with previous evidence that the potassium ion stimulates the adrenal cortex directly to secrete aldosterone. Peripheral renin activity did not increase after the potassium infusion. Plasma cortisol and corticosterone levels generally followed the expected diurnal decline during the infusion, implying that ACTH secretion did not increase. The plasma aldosterone response to incremental changes in serum potassium was linear on each of the four diets. The slopes of these linear relationships increased significantly when the potassium intake was increased from 40 to 200 mEq. No increase in slope occurred on either potassium intake when dietary sodium was restricted from 200 to 10 mEq. Thus, identical increases in serum potassium were associated with greater increments in plasma aldosterone above preinfusion levels on either sodium intake when the 200 mEq potassium diet was compared with the 40 mEq potassium intake.

ALDOSTERONE SECRETION RATES IN CHILDREN WITH NORMAL ADRENAL FUNCTION

Aldosterone secretion rate (ASR) was measured in 17 children during low, normal, and high dietary sodium intakes. Their ages varied from 3 months to 16 years; there were eight girls and nine boys. The average ASR with low, normal, and high sodium intakes were 236, 77, and 18 µg/ day respectively. The independent contribution of patient age, sex, sodium and potassium intake, and duration of fixed sodium intake was tested by least squares multiple regression analysis. The most important independent variable was sodium intake, although the sex and age of the patient were statistically significant variables. From this study it seems unlikely that precise control of all nutrients is necessary for evaluation of ASR if careful attention is paid to sodium intake.

Chronic sodium chloride challenge studies in man.

Abstract 1.1. In spite of a fixed sodium chloride intake, daily sodium excretion may vary widely. 2.2. The sodium balance pattern of larger subjects given proportionately larger sodium loads presents a sinusoidal configuration comprising an alternation of positivity and negativity in spite of a fixed sodium intake. 3.3. The amplitude of the oscillations of sodium excretion is a linear function of the magnitude of the daily sodium chloride load in the short run in all normal patients. 4.4. The gastrointestinal absorption of sodium chloride in the amounts given is practically complete; the fecal excretion of sodium is insignificant. 5.5. The urinary potassium excretion in spite of sodium chloride loading as described is generally constant throughout. 6.6. Hypothetical interrelationships of the above with current concepts of electrolyte metabolism are discussed. 7.7. Clinical and physiologic interpretations of single 24 hour urinary sodium excretion data must be made with caution.