This Article Full Text Full Text (PDF) All Versions of this Article: 48/4/527    most recent 01.HYP.0000240268.37379.7cv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sachdeva, A. Articles by Weder, A. B. Search for Related Content PubMed PubMed Citation Articles by Sachdeva, A. Articles by Weder, A. B. Related Collections Secondary prevention Other hypertension Clinical Studies Other etiology

(Hypertension. 2006;48:527.)
© 2006 American Heart Association, Inc.

Brief Reviews

Nocturnal Sodium Excretion, Blood Pressure Dipping, and Sodium Sensitivity

From the University of Michigan Medical School, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor.

Correspondence to Alan B. Weder, University of Michigan Medical School, Department of Internal Medicine, Division of Cardiovascular Medicine, 24 Frank Lloyd Wright Dr, Lobby M, Box 322, Ann Arbor, MI 48106. E-mail aweder@umich.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
More than 30 years ago, Guyton¹ described pressure- natriuresis: increasing arterial blood pressure promotes sodium excretion, decreasing blood volume and lowering blood pressure, whereas when blood pressure falls, sodium excretion decreases, and blood volume and blood pressure increase.^1,2 The linchpin of the model of Guyton et al³ is the concept of feedback gain. Gain is the degree to which a feedback system can correct a perturbation, that is, the amount of correction of a deviation divided by the residual degree of deviation. When a control system corrects a perturbation minimally, its feedback gain is near 0. When it corrects it completely, its gain is infinite. As emphasized by Guyton et al,³ in integrated systems with infinite and finite gain components, the infinite gain function ultimately dominates. There are myriad blood pressure control systems, for example, arterial baroreceptors and chemoreceptors, the central nervous system ischemic response, the renin–angiotensin system, and capillary fluid shift, but all are ultimately trumped by pressure–natriuresis. In the experiments by Guyton et al,³ pressure-natriuresis had near infinite gain over a wide range of urinary sodium excretion, such that the set point of blood pressure regulation was not affected by sodium intake over a period of several days or a few weeks.

This pressure–natriuresis model describes a steady-state relationship. At short time intervals, blood pressure and sodium excretion may not be closely linked, but the body will always eventually bring the system back into balance. In this review, we wish to draw attention to differences in the relationship . . . [Full Text of this Article]

This article has been cited by other articles:

				V. Pogue, M. Rahman, M. Lipkowitz, R. Toto, E. Miller, M. Faulkner, S. Rostand, L. Hiremath, M. Sika, C. Kendrick, et al. Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease Hypertension, January 1, 2009; 53(1): 20 - 27. [Abstract] [Full Text] [PDF]

				L. Bankir, M. Bochud, M. Maillard, P. Bovet, A. Gabriel, and M. Burnier Nighttime Blood Pressure and Nocturnal Dipping Are Associated With Daytime Urinary Sodium Excretion in African Subjects Hypertension, April 1, 2008; 51(4): 891 - 898. [Abstract] [Full Text] [PDF]

				H. Zhu, W. Yan, D. Ge, F. A. Treiber, G. A. Harshfield, G. Kapuku, H. Snieder, and Y. Dong Relationships of Cardiovascular Phenotypes With Healthy Weight, at Risk of Overweight, and Overweight in US Youths Pediatrics, January 1, 2008; 121(1): 115 - 122. [Abstract] [Full Text] [PDF]

				L. Bankir, J. Perucca, and M. H. Weinberger Ethnic Differences in Urine Concentration: Possible Relationship to Blood Pressure Clin. J. Am. Soc. Nephrol., March 1, 2007; 2(2): 304 - 312. [Abstract] [Full Text] [PDF]

				G. Cornelissen, F. Halberg, K. Otsuka, R.B. Singh, and C.-H. Chen Chronobiology Predicts Actual and Proxy Outcomes when Dipping Fails Hypertension, January 1, 2007; 49(1): 237 - 239. [Full Text] [PDF]