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Blood Pressure and Diurnal Variation in Sodium, Potassium, and Water Excretion

09:11 EDT 24th April 2014 | BioPortfolio

Summary

To determine if hypertensives and normotensives of similar ages had, on average, different ratios of 24-hour to overnight excretion of sodium, potassium, and water. Also, to determine the number of 24-hour collections needed to characterize individuals with respect to the ratios of 24-hour to overnight excretion and to determine if the ratios of 24-hour to overnight excretion vary by age and other factors related to blood pressure.

Description

BACKGROUND:

For decades excess sodium intake has been implicated in the etiopathogenesis of high blood pressure. Data from epidemiological, clinical, and animal experimental studies all suggest a direct casual association between excess salt intake and hypertension. Several investigators suggest that hypertension is the result of an inability of the kidney to excrete salt and water normally. It is hypothesized that the development of chronic blood pressure elevation results from the kidney's need to increase urine volume and sodium excretion -- in the presence of habitual high sodium intake -- in order to maintain homeostasis of the extracellular fluid volume.

Diurnal variations in excretion of sodium, chloride, potassium and water have been observed in several studies. Water and electrolyte excretion in normal individuals generally reaches a maximum sometime around midday with a minimum toward the end of the sleep period. These studies suggest that the daytime excretion rate exceeds the nighttime rate by 50 to 100 percent. Overnight urine collections have been used in many studies since they are easier to obtain, but they do not provide a direct estimate of the actual intake of sodium or potassium. In order to estimate actual intake, overnight values must be corrected to 24-hour values, that is, by multiplying the overnight values by previously determined ratios of 24-hour to overnight excretions. Preliminary studies by this group of investigators in hypertensives were the first which computed 24-hour to overnight ratios for excretion of sodium, potassium and creatinine in a definite way. This study in hypertensives showed a reversal of the diurnal cycle of sodium excretion. What is not clear in this study and others is whether the reversal is associated with hypertension or reflects decreased renal function with age or whether deterioration of renal function is due to the kidney readjusting its output of salt and water to maintain homeostasis in the face of both an excess sodium intake and a highly variable day to day intake. In addition, it may be that an abnormal diurnal pattern of sodium excretion may indicate that one is at risk of development of hypertension.

DESIGN NARRATIVE:

Each participant provided three 24-hour urine collections, divided into daytime and overnight specimens for the assessment of sodium, potassium, creatinine, and water excretion. Four blood pressure measurements were made. Height and weight were measured. Information was collected on demographic variables, alcohol intake, history and treatment of blood pressure, medication use, family history of high blood pressure, cigarette use, and changes in dietary habits. Analysis of variance was the primary method of data analysis.

Study Design

Observational Model: Natural History

Conditions

Cardiovascular Diseases

Status

Completed

Source

National Heart, Lung, and Blood Institute (NHLBI)

Results (where available)

View Results

Links

Medical and Biotech [MESH] Definitions

Pathological conditions involving the CARDIOVASCULAR SYSTEM including the HEART; the BLOOD VESSELS; or the PERICARDIUM.

Methods and procedures for the diagnosis of diseases or dysfunction of the cardiovascular system or its organs or demonstration of their physiological processes.

Unexpected rapid natural death due to cardiovascular collapse within one hour of initial symptoms. It is usually caused by the worsening of existing heart diseases. The sudden onset of symptoms, such as CHEST PAIN and CARDIAC ARRHYTHMIAS, particularly VENTRICULAR TACHYCARDIA, can lead to the loss of consciousness and cardiac arrest followed by biological death. (from Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., 2005)

Processes and properties of the CARDIOVASCULAR SYSTEM as a whole or of any of its parts.

Dental care for patients with chronic diseases. These diseases include chronic cardiovascular, endocrinologic, hematologic, immunologic, neoplastic, and renal diseases. The concept does not include dental care for the mentally or physically disabled which is DENTAL CARE FOR DISABLED.

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