Study of pathogenesis of salt-sensitive hypertension: Japan-US cooperative study

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On the diagnostic criteria of non-modulator, who concomitantly fails to modulate the adrenal and the renovascular responses to change in sodium chloride intake, in white patients with normal-renin essential hypertension (NR-EHT) by G.H.Williams et al. (Harvard Medical School, Boston, MA), we examined the incidence of non-modulator in Japanese patients with NR-EHT and the relation between non-modulation and salt sensitivity. Eighteen out of 21 patients with HET were diagnosed as NR-EHT. A preliminary study performed on 5 normotensive sudjects showed the criteria were applicable to Japanese subjects. Sodium chloride balance study, 250 mEg NaCl a day for a week (high sodium period) followed by 10 mEg NaCl a day for a week (low sodium period), were performed and on the last day of each period the renovascular and the adrenal responses to 3.0 ng/Kg/min of angiotensin II(AII) were examined. The decrease in renal plasma flow (RPF) by AII measured by para-aminohippurate clearance less than 120 … More ml/min/1.73m^2 in the high sodium period was designated as non-modulator of the renovascular system. The increase in plasma aldosterone concentration(PAC) by AII less than 150 pg/ml in the low sodium period was designated as non-modulator of the adrenal gland. The incidence of non-modulator in Japanese patients with NR-EHT was 16.7%(3/18) by the renovascular response or 61.1%(11/18) by the adrenal response. There were only three patients who were diagnosed non-modulator by the both criteria concomitantly. The incidence of non-modulator in Japanese diagnosed by the adrenal response was similar to that in the United States. There was no significant differences in changes of RPF, PAC, serum electrolytes, erythrocytic Na transport systems, platelet AII receptor and Ca-regulating hormones with sodium chloride balance study between modulator and non-modulator. Salt sensitivity (change in mean blood pressure from high to low sodium period) showed negative correlation with changes in the adrenal response to AII from high to low sodium period, but not with those in renovascular response, Na transport systems, platelet AII receptor, Ca-regulating hormones.In summary, it was suggested that in Japanese patients with NR-EHT modulation of adrenal gland and renovascular system was independent each other. The incidence of non-modulator in Japanese patients with NR-EHT diagnosed by adrenal response to extrinsic AII was 61% and similar to that in the United States. Modulation of the adrenal gland may play some role on salt sensitivity in patients with NR-EHT. Less