Document Detail


Dietary sodium, aldosterone, and left ventricular mass changes during long-term inhibition of the renin-angiotensin system.
MedLine Citation:
PMID:  20921428     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In essential hypertension, the regression of left ventricular hypertrophy is an important goal of treatment. In addition to treatment-associated changes in blood pressure (BP), the roles of other determinants of left ventricular hypertrophy regression, including dietary sodium intake, deserve investigation. In the present study, the change in echographic left ventricular mass index (LVMI) was assessed in 182 patients with never-treated essential hypertension at baseline and after 3 years of treatment by angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists given at recommended doses and associated with other antihypertensive agents. Treatment was associated with satisfactory control of BP (<140/90 mm Hg) in 64% of patients, and left ventricular hypertrophy prevalence decreased from 56% to 39%. Twenty-four-hour urinary sodium was positively related to LVMI at baseline and at the end of the study, independently of age, sex, and systolic BP. Supine plasma aldosterone concentration was correlated with LVMI only at baseline but not in multivariate analysis. In response to treatment, the percentage of change in LVMI was positively correlated with the absolute changes in systolic BP, urinary sodium, and plasma aldosterone concentration, independently of baseline LVMI. The population was divided into 3 tertiles according to final values of gender-specific urinary sodium. When, within each urinary sodium tertile, patients were divided into those with plasma aldosterone concentration below and above the median (11.6 ng/dL), LVMI progressively increased across sodium tertiles only in patients with high plasma aldosterone concentration. Systolic BP was similar across all of the groups. In conclusion, aldosterone requires the presence of high dietary salt for the expression of its unfavorable effect on the heart.
Authors:
Guilhem du Cailar; Pierre Fesler; Jean Ribstein; Albert Mimran
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Publication Detail:
Type:  Journal Article     Date:  2010-10-04
Journal Detail:
Title:  Hypertension     Volume:  56     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-21     Completed Date:  2010-11-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  865-70     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Centre Hospitalier Universitaire, Montpellier, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aldosterone / blood*
Analysis of Variance
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Antihypertensive Agents / therapeutic use
Blood Pressure / drug effects
Echocardiography
Female
Follow-Up Studies
Humans
Hypertension / blood,  complications,  drug therapy,  physiopathology*
Hypertrophy, Left Ventricular / blood,  complications,  drug therapy,  physiopathology*
Linear Models
Male
Middle Aged
Renin-Angiotensin System / drug effects*
Sodium, Dietary*
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Sodium, Dietary; 52-39-1/Aldosterone
Comments/Corrections
Comment In:
Hypertension. 2010 Nov;56(5):804-5   [PMID:  20921423 ]

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