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. 1981 Aug 15;283(6289):463–468. doi: 10.1136/bmj.283.6289.463

Sodium and potassium in essential hypertension.

A F Lever, C Beretta-Piccoli, J J Brown, D L Davies, R Fraser, J I Robertson
PMCID: PMC1506255  PMID: 6790017

Abstract

A study was carried out of arterial pressure and body content of electrolytes in 91 patients with essential hypertension and 121 normal controls. Exchangeable sodium was found to be positively correlated with arterial pressure in the patients, the correlation being closest in older patients; values of exchangeable sodium were subnormal in young patients; and plasma, exchangeable, and total body potassium correlated inversely with arterial pressure in the patients, the correlations being closest in young patients. Three hypotheses were proposed to explain the mechanisms relating electrolytes and arterial pressure in essential hypertension--namely, a cell-salt hypothesis, a dietary salt hypothesis, and a kidney-salt hypothesis. It was concluded that two mechanisms probably operate in essential hypertension. In the early stages of the disease blood pressure is raised by an abnormal process related more closely to potassium than to sodium. A renal lesion develops later, possibly as a consequence of the hypertension. This lesion is characterised by resetting of pressure natriuresis and is manifest by an abnormal relation between body sodium and arterial pressure and by susceptibility to increased dietary sodium intake.

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Selected References

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  1. Atkinson A. B., Davies D. L., Leckie B., Morton J. J., Brown J. J., Fraser R., Lever A. F., Robertson J. I. Hyponatraemic hypertensive syndrome with renal-artery occlusion corrected by captopril. Lancet. 1979 Sep 22;2(8143):606–609. doi: 10.1016/s0140-6736(79)91666-0. [DOI] [PubMed] [Google Scholar]
  2. BORST J. G., BORST-DE GEUS A. Hypertension explained by Starling's theory of circulatory homoeostasis. Lancet. 1963 Mar 30;1(7283):677–682. doi: 10.1016/s0140-6736(63)91443-0. [DOI] [PubMed] [Google Scholar]
  3. Barraclough M. A. Sodium and water depletion with acute malignant hypertension. Am J Med. 1966 Feb;40(2):265–272. doi: 10.1016/0002-9343(66)90107-0. [DOI] [PubMed] [Google Scholar]
  4. Beretta-Piccoli C., Weidmann P., De Châtel R., Reubi F. Hypertension associated with early stage kidney disease. Complementary roles of circulating renin, the body sodium/volume state and duration of hypertension. Am J Med. 1976 Nov;61(5):739–747. doi: 10.1016/0002-9343(76)90155-8. [DOI] [PubMed] [Google Scholar]
  5. Bianchi G., Ponticelli C., Bardi U., Redaelli B., Campolo L., De Ponti C., Graziani G. Role of the kidney in 'salt and water dependent hypertension' of end-stage disease. Clin Sci. 1972 Jan;42(1):47–55. doi: 10.1042/cs0420047. [DOI] [PubMed] [Google Scholar]
  6. Birkenhäger W. H., Schalekamp M. A., Krauss X. H., Kolsters G., Schalekamp-Kuyken M. P., Kroon B. J., Teulings F. A. Systemic and renal haemodynamics, body fluids and renin in benign essential hypertension with special reference to natural history. Eur J Clin Invest. 1972 Jan;2(2):115–122. doi: 10.1111/j.1365-2362.1972.tb00579.x. [DOI] [PubMed] [Google Scholar]
  7. Boddy K., Brown J. J., Davies D. L., Elliott A., Harvey I., Haywood J. K., Holloway I., Lever A. F., Robertson J. I., Williams E. D. Concurrent estimation of total body and exchangeable body sodium in hypertension. Clin Sci Mol Med. 1978 Feb;54(2):187–191. doi: 10.1042/cs0540187. [DOI] [PubMed] [Google Scholar]
  8. Brown J. J., Lever A. F., Robertson J. I. Pathogenesis of essential hypertension. Lancet. 1976 Jun 5;1(7971):1217–1219. doi: 10.1016/s0140-6736(76)92164-4. [DOI] [PubMed] [Google Scholar]
  9. Brown W. J., Jr, Brown F. K., Krishan I. Exchangeable sodium and blood volume in normotensive and hypertensive humans on high and low sodium intake. Circulation. 1971 Apr;43(4):508–519. doi: 10.1161/01.cir.43.4.508. [DOI] [PubMed] [Google Scholar]
  10. Canessa M., Adragna N., Solomon H. S., Connolly T. M., Tosteson D. C. Increased sodium-lithium countertransport in red cells of patients with essential hypertension. N Engl J Med. 1980 Apr 3;302(14):772–776. doi: 10.1056/NEJM198004033021403. [DOI] [PubMed] [Google Scholar]
  11. DE GRAEFF J. Inulin space and total exchangeable sodium in patients with essential hypertension. Acta Med Scand. 1957 Jan 15;156(5):337–350. doi: 10.1111/j.0954-6820.1957.tb00092.x. [DOI] [PubMed] [Google Scholar]
  12. Dahl L. K., Leitl G., Heine M. Influence of dietary potassium and sodium/potassium molar ratios on the development of salt hypertension. J Exp Med. 1972 Aug 1;136(2):318–330. doi: 10.1084/jem.136.2.318. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Dathan J. R., Johnson D. B., Goodwin F. J. The relationship between body fluid compartment volumes, renin activity and blood pressure in chronic renal failure. Clin Sci. 1973 Jul;45(1):77–88. doi: 10.1042/cs0450077. [DOI] [PubMed] [Google Scholar]
  14. Davies D. L., Beevers D. G., Briggs J. D., Medina A. M., Robertson J. I., Schalekamp M. A., Brown J. J., Lever A. F., Morton J. J., Tree M. Abnormal relation between exchangeable sodium and the renin-angiotensin system in malignant hypertension and in hypertension with chronic renal failure. Lancet. 1973 Mar 31;1(7805):683–686. doi: 10.1016/s0140-6736(73)91476-1. [DOI] [PubMed] [Google Scholar]
  15. Edmondson R. P., Thomas R. D., Hilton P. J., Patrick J., Jones N. F. Abnormal leucocyte composition and sodium transport in essential hypertension. Lancet. 1975 May 3;1(7914):1003–1005. doi: 10.1016/s0140-6736(75)91947-9. [DOI] [PubMed] [Google Scholar]
  16. Ferriss J. B., Beevers D. G., Boddy K., Brown J. J., Davies D. L., Fraser R., Kremer D., Lever A. F., Robertson J. I. The treatment of low-renin ("primary") hyperaldosteronism. Am Heart J. 1978 Jul;96(1):97–109. doi: 10.1016/0002-8703(78)90132-1. [DOI] [PubMed] [Google Scholar]
  17. Freis E. D. Salt, volume and the prevention of hypertension. Circulation. 1976 Apr;53(4):589–595. doi: 10.1161/01.cir.53.4.589. [DOI] [PubMed] [Google Scholar]
  18. Fujita T., Henry W. L., Bartter F. C., Lake C. R., Delea C. S. Factors influencing blood pressure in salt-sensitive patients with hypertension. Am J Med. 1980 Sep;69(3):334–344. doi: 10.1016/0002-9343(80)90002-9. [DOI] [PubMed] [Google Scholar]
  19. Garay R. P., Dagher G., Pernollet M. G., Devynck M. A., Meyer P. Inherited defect in a Na+, K-co-transport system in erythrocytes from essential hypertensive patients. Nature. 1980 Mar 20;284(5753):281–283. doi: 10.1038/284281a0. [DOI] [PubMed] [Google Scholar]
  20. Girardin E., Caverzasio J., Iwai J., Bonjour J. P., Muller A. F., Grandchamp A. Pressure natriuresis in isolated kidneys from hypertension-prone and hypertension-resistant rats (Dahl rats). Kidney Int. 1980 Jul;18(1):10–19. doi: 10.1038/ki.1980.105. [DOI] [PubMed] [Google Scholar]
  21. Guyton A. C., Coleman T. G., Cowley A. V., Jr, Scheel K. W., Manning R. D., Jr, Norman R. A., Jr Arterial pressure regulation. Overriding dominance of the kidneys in long-term regulation and in hypertension. Am J Med. 1972 May;52(5):584–594. doi: 10.1016/0002-9343(72)90050-2. [DOI] [PubMed] [Google Scholar]
  22. HOLLANDER W., CHOBANIAN A. V., BURROWS B. A. Body fluid and electrolyte composition in arterial hypertension. I. Studies in essential, renal and malignant hypertension. J Clin Invest. 1961 Feb;40:408–415. doi: 10.1172/JCI104268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Haddy F., Pamnani M., Clough D. The sodium-potassium pump in volume expanded hypertension. Clin Exp Hypertens. 1978;1(3):295–336. doi: 10.3109/10641967809068611. [DOI] [PubMed] [Google Scholar]
  24. Kawasaki T., Delea C. S., Bartter F. C., Smith H. The effect of high-sodium and low-sodium intakes on blood pressure and other related variables in human subjects with idiopathic hypertension. Am J Med. 1978 Feb;64(2):193–198. doi: 10.1016/0002-9343(78)90045-1. [DOI] [PubMed] [Google Scholar]
  25. LOSSE H., WEHMEYER H., WESSELS F. [The water- and electrolyte content of erythrocytes in arterial hypertension]. Klin Wochenschr. 1960 Apr 15;38:393–395. doi: 10.1007/BF01483466. [DOI] [PubMed] [Google Scholar]
  26. Lebel M., Schalekamp M. A., Beevers D. G., Brown J. J., Davies D. L., Fraser R., Kremer D., Lever A. F., Morton J. J., Robertson J. I. Sodium and the renin-angiotensin system in essential hypertension and mineralocorticoid excess. Lancet. 1974 Aug 10;2(7876):308–309. doi: 10.1016/s0140-6736(74)91690-0. [DOI] [PubMed] [Google Scholar]
  27. Ledingham J. M. The etiology of hypertension. Practitioner. 1971 Jul;207(237):5–19. [PubMed] [Google Scholar]
  28. Lowenstein J., Beranbaum E. R., Chasis H., Baldwin D. S. Intrarenal pressure and exaggerated natriuresis in essential hypertension. Clin Sci. 1970 Mar;38(3):359–374. doi: 10.1042/cs0380359. [DOI] [PubMed] [Google Scholar]
  29. Luft F. C., Rankin L. I., Bloch R., Weyman A. E., Willis L. R., Murray R. H., Grim C. E., Weinberger M. H. Cardiovascular and humoral responses to extremes of sodium intake in normal black and white men. Circulation. 1979 Sep;60(3):697–706. doi: 10.1161/01.cir.60.3.697. [DOI] [PubMed] [Google Scholar]
  30. Overbeck H. W., Derifield R. S., Pamnani M. B., Sözen T. Attenuated vasodilator responses to K+ in essential hypertensive men. J Clin Invest. 1974 Mar;53(3):678–686. doi: 10.1172/JCI107605. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Parfrey P. S., Condon K., Wright P., Vandenburg M. J., Holly J. M., Goodwin F. J., Evans S. J., Ledingham J. M. Blood pressure and hormonal changes following alteration in dietary sodium and potassium in young men with and without a familial predisposition to hypertension. Lancet. 1981 Jan 17;1(8212):113–117. doi: 10.1016/s0140-6736(81)90707-8. [DOI] [PubMed] [Google Scholar]
  32. Parfrey P. S., Vandenburg M. J., Wright P., Holly J. M., Goodwin F. J., Evans S. J., Ledingham J. M. Blood pressure and hormonal changes following alteration in dietary sodium and potassium in mild essential hypertension. Lancet. 1981 Jan 10;1(8211):59–63. doi: 10.1016/s0140-6736(81)90001-5. [DOI] [PubMed] [Google Scholar]
  33. Reubi F. C., Weidmann P. Relationships between sodium clearance, plasma renin activity, plasma aldosterone, renal hemodynamics and blood pressure in essential hypertension. Clin Exp Hypertens. 1980;2(3-4):593–612. doi: 10.3109/10641968009037132. [DOI] [PubMed] [Google Scholar]
  34. Safar M. E., London G. M., Weiss Y. A., Milliez P. L. Overhydratation and renin in hypertensive patients with terminal renal failure: a hemodynamic study. Clin Nephrol. 1975 Nov;4(5):183–188. [PubMed] [Google Scholar]
  35. Sullivan J. M., Ratts T. E., Taylor J. C., Kraus D. H., Barton B. R., Patrick D. R., Reed S. W. Hemodynamic effects of dietary sodium in man: a preliminary report. Hypertension. 1980 Jul-Aug;2(4):506–514. doi: 10.1161/01.hyp.2.4.506. [DOI] [PubMed] [Google Scholar]
  36. TOBIAN L., JANECEK J., TOMBOULIAN A., FERREIRA D. Sodium and potassium in the walls of arterioles in experimental renal hypertension. J Clin Invest. 1961 Oct;40:1922–1925. doi: 10.1172/JCI104417. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Thompson J. M., Dickinson C. J. The relation between the excretion of sodium and water and the perfusion pressure in the isolated, blood-perfused, rabbit kidney, with special reference to changes occurring in clip-hypertension. Clin Sci Mol Med. 1976 Mar;50(3):223–236. doi: 10.1042/cs0500223. [DOI] [PubMed] [Google Scholar]
  38. Tobian L., Johnson M. A., Lange J., Magraw S. Effect of varying perfusion pressures on the output of sodium and renin and the vascular resistance in kidneys of rats with "post-salt" hypertension and Kyoto spontaneous hypertension. Circ Res. 1975 Jun;36(6 Suppl 1):162–170. doi: 10.1161/01.res.36.6.162. [DOI] [PubMed] [Google Scholar]
  39. Tobian L., Lange J., Iwai J., Hiller K., Johnson M. A., Goossens P. Prevention with thiazide of NaCl-induced hypertension in Dahl "S" rats. Evidence for a Na-retaining humoral agent in "S" rats. Hypertension. 1979 May-Jun;1(3):316–323. doi: 10.1161/01.hyp.1.3.316. [DOI] [PubMed] [Google Scholar]
  40. Wambach G., Helber A., Bönner G., Hummerich W. Natrium-Kalium--Adenosintriphosphatase-Aktivität in Erythrozytenghosts von Patienten mit essentielier Hypertonie. Klin Wochenschr. 1979 Feb 15;57(4):169–172. doi: 10.1007/BF01477404. [DOI] [PubMed] [Google Scholar]
  41. Willassen Y., Ofstad J. Renal sodium excretion and the peritubular capillary physical factors in essential hypertension. Hypertension. 1980 Nov-Dec;2(6):771–779. doi: 10.1161/01.hyp.2.6.771. [DOI] [PubMed] [Google Scholar]
  42. Woods J. W., Liddle G. W., Michelakis A. M., Brill A. B. Effect of an adrenal inhibitor in hypertensive patients with suppressed renin. Arch Intern Med. 1969 Apr;123(4):366–370. [PubMed] [Google Scholar]
  43. de Wardener H. E., MacGregor G. A. Dahl's hypothesis that a saluretic substance may be responsible for a sustained rise in arterial pressure: its possible role in essential hypertension. Kidney Int. 1980 Jul;18(1):1–9. doi: 10.1038/ki.1980.104. [DOI] [PubMed] [Google Scholar]

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