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salt-sensitive hypertension (ssHTN)
Etiology:
- habitual high dietary sodium with low dietary potassium [3]
Epidemiology:
- may be more common in African Americans than whites
- may be more common in overweight & obese, even in children & adolescents [2]
Pathology:
- expansion of intravascular volume
- proliferation of lymphatic vessels under the skin that store excess fluid; this lessens intravascular volume, thus, attenuates the rise in blood pressure that resuls from initial salt loading [1] (in mice)
- proliferation of lymphatic vessels is produced by the angiogenesis molecule VEGF-C, which is stimulated by another molecule NFAT5 (TonEBP) that is produced in response to hypertonic conditions
- defects in this system may cause salt-sensitive hypertension
Management:
- dietary salt restriction (low-salt diet, DASH diet)
- diuretic as adjunct to diet may be necessary
General
chronic hypertension
References
- Machnik A et al
Macrophages regulate salt-dependent volume and blood pressure
by a vascular endothelial growth factor-C dependent buffering
mechanism.
Nat Med 2009 May; 15:545
PMID: 19412173
- Yang Q et al
Sodium Intake and Blood Pressure Among US Children and
Adolescents.
Pediatrics Sept 17, 2012
PMID: 22987869
http://pediatrics.aappublications.org/content/early/2012/09/12/peds.2011-3870.abstract
- Medical Knowledge Self Assessment Program (MKSAP) 19.
American College of Physicians, Philadelphia 2021