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Hypertension, Vol 23, 531-550, Copyright © 1994 by American Heart Association
VM Campese
The mechanisms responsible for the increase in blood pressure response to
high salt intake in salt-sensitive patients with essential hypertension are
complex and only partially understood. A complex interaction between
neuroendocrine factors and the kidney may underlie the propensity for such
patients to retain salt and develop salt- dependent hypertension. The
possible role of vasodilator and natriuretic agents, such as the
prostaglandins, endothelium-derived relaxing factor, atrial natriuretic
factor, and kinin-kallikrein system, requires further investigation. An
association between salt sensitivity and a greater propensity to develop
renal failure has been described in certain groups of hypertensive
patients, such as blacks, the elderly, and those with diabetes mellitus.
Salt-sensitive patients with essential hypertension manifest a deranged
renal hemodynamic adaptation to a high dietary salt intake. During a low
salt diet, salt- sensitive and salt-resistant patients have similar mean
arterial pressure, glomerular filtration rate, effective renal plasma flow,
and filtration fraction. On the other hand, during a high salt intake
glomerular filtration rate does not change in either group, and effective
renal blood flow increases in salt-resistant but decreases in
salt-sensitive patients; filtration fraction and glomerular capillary
pressure decrease in salt-resistant but increase in salt-sensitive
patients. Salt-sensitive patients are also more likely than salt- resistant
patients to manifest left ventricular hypertrophy, microalbuminuria, and
metabolic abnormalities that may predispose them to cardiovascular
diseases. In conclusion, salt sensitivity in hypertension is associated
with substantial renal, hemodynamic, and metabolic abnormalities that may
enhance the risk of cardiovascular and renal morbidity.
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Salt sensitivity in hypertension. Renal and cardiovascular implications [clinical conference]
Department of Medicine, University of Southern California Medical Center, Los Angeles 90033.
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