Different patterns of cellular sodium turnover in essential hypertension

Erythrocyte sodium turnover was studied in 22 men aged 56 years who had been treated for hypertension for 7 years. Investigations were performed during treatment, and 1 and 4 weeks after withdrawal of therapy, and when hypertension had returned (blood pressure greater than or equal to 170/105 mmHg). Hypertension returned early in 11 patients (group A) and late in 11 patients (group B). There was no difference in blood pressure, therapy, body weight or peripheral resistance between the groups, but group A had a greater left ventricular mass. Intra-erythrocyte sodium was determined by flame photometry. Sodium influx and the rate constant of sodium efflux were calculated from uptake values of 22Na. In group B the return of hypertension was accompanied by a tendency for an increase in intra-erythrocyte sodium and a decrease in sodium efflux. In group A opposing changes were seen, so that significant differences occurred in sodium efflux and intra-erythrocyte sodium between the groups occurred at the reappearance of hypertension. The results are compatible with the appearance of a membrane abnormality in patients with a slow return of hypertension, whereas other mechanisms, e.g. increased sympathetic activity, may be associated with the more rapid rise in blood pressure in the other group.