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Do hypertensive patients have a different diurnal pattern of electrolyte excretion?
1Department of Community Health and Preventive Medicine, Northwestern University Medical School, Chicago, Illinois.
Insights
Hypertensive patients often excrete more sodium and water during sleep than during waking hours, reversing the typical pattern. This finding suggests unique diurnal excretion patterns in hypertension.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Hypertension Research
Background:
- Normal diurnal patterns show greater excretion of sodium, potassium, and water during the day than at night.
- Hypertension is a significant global health concern, and understanding its physiological underpinnings is crucial for effective management.
Purpose of the Study:
- To investigate diurnal excretion patterns of sodium, potassium, creatinine, and water in hypertensive individuals.
- To compare these patterns with those of normotensive or high-normal blood pressure subjects.
Main Methods:
- Analysis of 24-hour urine collections (daytime vs. overnight) from 107 hypertensive patients in the Hypertension Control Program.
- Subgroup analysis based on demographics, treatment, and hypertension severity.
- Comparison with a control group of 30 individuals with high-normal blood pressure.
Main Results:
- Over half of hypertensive participants showed greater sodium and water excretion during sleep than during the day.
- Women and Black individuals exhibited significantly lower sodium/water and water/potassium excretion ratios, respectively, compared to men and White individuals.
- Hypertensive patients displayed significantly lower sodium and water excretion ratios than those with high-normal blood pressure.
Conclusions:
- Hypertensive patients may exhibit reversed diurnal excretion patterns for sodium and water compared to normotensive individuals.
- Sex and race influence diurnal electrolyte and water excretion patterns in hypertension.
- These findings highlight potential differences in fluid and electrolyte balance in hypertension, warranting further investigation.
Abstract:
Studies generally indicate that excretion of sodium, potassium, and water is greater during the day than during the night. To determine whether hypertensive patients exhibit this same pattern of excretion, diurnal variations in excretion of sodium, potassium, creatinine, and water were examined in 107 hypertensive men and women from a clinical trial on control of hypertension by nonpharmacological means--the Hypertension Control Program. Each participant provided two carefully timed 24-hour urine collections divided into daytime and overnight specimens. The median ratios of 24-hour to 8-hour overnight excretion were 2.84, 3.95, 2.99, and 2.77 for sodium, potassium, creatinine, and water, respectively. Thus, more than half of this hypertensive group exhibited a greater rate of sodium and water excretion during sleep than during daytime hours, a reversal of the usual pattern. When the group was subdivided based on age, sex, race, trial randomization group, use of diuretics, and hypertension severity, women had significantly lower ratios of 24-hour to overnight excretion for sodium and water than men and blacks had significantly lower 24-hour to overnight ratios for water and potassium than whites. When the 24-hour to overnight ratios for these hypertensive patients were compared with those for a group of 30 men and women with high-normal blood pressure, those with high-normal blood pressure had significantly larger ratios for sodium and water excretion than the hypertensive group. The results of this study suggest that hypertensive patients may have a different diurnal pattern of sodium and water excretion than normotensive subjects and that further research is needed to clarify this issue.