Ferri C, Bellini C, Desideri G, DiFrancesco L, et al.
Increased endothelin-1 levels in human salt-sensitive
hypertension
11th Scientific Meeting, American Society of Hypertension
Am J Hypert
(Apr) 9:79A 1996
The role of endothelin-1(ET) and von Willebrand factor (vWF) in
hypertension has been implied but not pathophysiologically defined in
studies of endothelial dysfunction. This study of twenty mildly
hypertensive patients was initiated by placing all subjects on a
"moderate" salt diet (120 mmol/day). Baseline urinary and plasma ET,
plasma vWF, and urinary albumin excretion were studied. ET was also
studied during an oral glucose tolerance test and angiotensin II infusion.
Subjects were then assigned to a high (210 mmol/day) or low (10
mmol/day) salt diet in a random, crossover, double blind fashion for two
consecutive two week periods and compared with 7 controls. Salt
sensitivity (defined as a greater than 10 mmHg fall in DBP during a low salt
diet) was
associated with higher urinary albumin excretion, urinary endothelin,
plasma endothelin, and insulin levels in response to the GTT than
controls or salt resistant hypertensives.
Comment:
The conclusion states that
these findings are early markers of vascular damage. Little comment is
made regarding the reasoning for use of a GTT of angiotensin infusion in
this study. Furthermore, some assessment of nitric oxide would have
been interesting in this study of its apparent antagonist endothelin. The
low salt diet is virtually impossible to achieve in outpatient life and one
wonders how this was carried out for two weeks. Finally, there is no
assessment or description of "vascular damage" incidence in these
patients provided to support the conclusion. (Sri Narsipur, MD, SUNY-HSC
at Syracuse, NY)
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11th Scientific Meeting, American Society of Hypertension
H: Pathophysiology :
Salt (sodium, chloride) sensitivity