Association of Filtered Sodium Load With Medullary Volumes and Medullary Hypoxia in Hypertensive African Americans as Compared With Whites
Open accessAbstract
Background African Americans develop hypertension earlier with more target manifestations than whites despite having a higher glomerular filtration rate (GFR) for any level of serum creatinine. STUDY DESIGN & PARTICIPANTS: This study tested the hypothesis that increased GFR and sodium reabsorption in African Americans is associated with increased metabolic work and medullary hypoxia in 49 nondiabetic patients with essential hypertension (29 whites and 20 African Americans) following a constant-sodium diet (150 mEq/d) and renin-angiotensin system blockade.Predictors Ethnicity, age, measured GFR, sodium excretion, and body mass index.Outcomes We examined cortical and medullary volumes and blood flows using multidetector computed tomography and intrarenal deoxyhemoglobin (R2*) using blood oxygen level-dependent magnetic resonance.Results Blood pressure and sodium excretion were similar, whereas African Americans were more obese and had higher iothalamate GFRs. Renal cortical volumes did not differ, but medullary volumes adjusted for body size and age were higher in African Americans (32.3 ± 11.2 vs 25.1 ± 7.4 cm(3)/m(2) body surface area; P < 0.001). Sodium reabsorption and blood flows were higher in African Americans. Basal cortical deoxyhemoglobin values were similar between ethnic groups, whereas medullary R2* was higher in African Americans (39.7 ± 5.1 vs 36.3 ± 6.5/s; P = 0.02), but decreased to levels similar to whites after furosemide treatment. Levels of the circulating isoprostane prostaglandin F(2α) were higher in African Americans and daily urinary prostaglandin F(2α) excretion in African Americans correlated directly with renal blood flow (R = 0.71; P < 0.01).Limitations Studies were limited to treated volunteers with normal kidney function without knowledge of prior nutrient intake.Conclusions These data show for the first time that increased sodium reabsorption in obese African American patients with hypertension was associated with enlarged medullary volumes, functional hypoxia related to solute reabsorption, and a direct relationship between blood flows and urinary isoprostane levels. Our results support a model of increased oxygen consumption and oxidative stress in African Americans that may accelerate hypertension and target-organ injury compared with white patients with essential hypertension.
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Chronically high dietary sodium may increase blood pressure to a greater extent than short- or intermediate-term intake.
“In terms of other physiologic effects, a large body of ecologic and experimental evidence suggests that chronically high dietary sodium may increase BP to a greater extent than short-or intermediate-term intake 28”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [28]
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- Authors
- Textor, S. C., Gloviczki, M. L., Flessner, M. F., Calhoun, D. A., Glockner, J., Grande, J. P., McKusick, M. A., Cha, S. S., & Lerman, L. O.
- Affiliations
- Mayo Clinic (US)
- National Institutes of Health (US)
- University of Alabama at Birmingham (US)
- Corresponding author
- Textor, Stephen C.
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 59
- Issue
- 2
- Pages
- 229-237
- ISSN
- 0272-6386 (ISSN-L)
- PMC
- PMC3259240
- OpenAlex
- W2082226925
- Cited by
- 30
- References
- 45
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 2 · 2021: 3 · 2020: 1 · 2019: 1 · 2017: 4 · 2016: 1 · 2015: 4 · 2014: 6 · 2013: 3 · 2012: 3
- FWCI
- 2.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Georgia Clinical and Translational Science Alliance
- National Institutes of Health
- National Heart, Lung, and Blood Institute (P01HL085307, P01 HL-85307)
- National Center for Research Resources (UL1RR024150)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Keywords
- African Americans, essential hypertension, medullary hypoxia, sodium reabsorption, renal blood flow, isoprostanes, oxidative stress, renal oxygen consumption, obesity, renin-angiotensin system blockade, furosemide
- MeSH terms
- Adult, Aged, Aged, 80 and over, Hypoxia, Black or African American, Blood Pressure, Diuretics, Furosemide, Glomerular Filtration Rate, Humans, Hypertension, Kidney Medulla, Middle Aged, Obesity, Organ Size, Sodium, Sodium, Dietary, Dinoprost, Comorbidity, White People
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