Skip to main content

Stress-induced sodium retention and hypertension: A review and hypothesis

Current Hypertension Reports volume 11, Article number: 29 (2009) Cite this article

Abstract

Hypertension—an important health problem in industrialized nations—is particularly significant in blacks and obese individuals, in whom it is hypothesized to result from impaired renal sodium regulation. We reviewed studies that identified individuals with impaired sodium regulation by examining the natriuretic response to mental stress. A significant percentage of black and obese individuals retain or have a diminished natriuretic response to mental stress despite increased blood pressure (BP). This contributes a volume component to the normal resistance-mediated BP increase, and BP remains elevated after the stressor ceases until the volume expansion diminishes. The stress exposes these individuals to greater cardiovascular load. This response pattern has been linked to renin-angiotensin-aldosterone system activity, and is associated with premature target-organ damage. Assessing stressinduced sodium retention provides a method to identify patients with impaired sodium regulation without using a dietary protocol that poses adherence difficulties, or complicated laboratory assessments. Furthermore, research using this technique indicates the effectiveness of renin-angiotensin-aldosterone system blockers in correcting impaired sodium regulation and consequent hypertension in these individuals.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References and Recommended Reading

  1. Franco V, Oparil S: Salt sensitivity, a determinant of blood pressure, cardiovascular disease and survival. J Am Coll Nutr 2006, 25(3 Suppl):247S–255S.

    PubMed  CAS  Google Scholar 

  2. Rodriguez-Iturbe B, Romero F, Johnson RJ: Pathophysiological mechanisms of salt-dependent hypertension. Am J Kidney Dis 2007, 50:655–672.

    PubMed  Article  Google Scholar 

  3. Weinberger MH: Pathogenesis of salt sensitivity of blood pressure. Curr Hypertens Rep 2006, 8:166–170.

    PubMed  Article  CAS  Google Scholar 

  4. Orlov SN, Mongin AA: Salt-sensing mechanisms in blood pressure regulation and hypertension. Am J Physiol 2007, 293:H2039–H2053.

    CAS  Google Scholar 

  5. Guyton AC: Textbook of Medical Physiology, edn 8. Philadelphia: WB Saunders; 1991.

    Google Scholar 

  6. Light KC, Koepke JP, Obrist PA, Willis PW: Psychological stress induces sodium and fluid retention in men at high risk for hypertension. Science 1983, 220:429–431.

    PubMed  Article  CAS  Google Scholar 

  7. Harshfield GA, Pulliam DA, Alpert BS: Patterns of sodium excretion during sympathetic nervous system arousal. Hypertension 1991, 17(6 Pt 2):1156–1160.

    Google Scholar 

  8. Rollnik JD, Mills PJ, Dimsdale JE: Characteristics of individuals who excrete versus retain sodium under stress. J Psychosom Res 1995, 39:499–505.

    PubMed  Article  CAS  Google Scholar 

  9. Fauvel JP, Najem R, Ryon B, et al.: Effects of rilmenidine on stress-induced peak blood pressure and renal function. J Cardiovasc Pharmacol 1999, 34:41–45.

    PubMed  Article  CAS  Google Scholar 

  10. Ducher M, Bertram D, Pozet N, et al.: Stress-induced renal alterations in normotensive offspring of hypertensives and in hypertensives. Am J Hypertens 2002, 15:346–350.

    PubMed  Article  Google Scholar 

  11. Light KC, Turner JR: Stress-induced changes in the rate of sodium excretion in healthy black and white men. J Psychosom Res 1992, 36:497–508.

    PubMed  Article  CAS  Google Scholar 

  12. Harshfield GA, Treiber FA, Davis H, Kapuku GK: Impaired stress-induced pressure natriuresis is related to left ventricle structure in blacks. Hypertension 2002, 39:844–847.

    PubMed  Article  CAS  Google Scholar 

  13. Harshfield G, Wilson M, Hanevold C, et al.: Impaired stress-induced pressure natriuresis increases cardiovascular load in African American youths. Am J Hypertens 2002, 15:903–906.

    PubMed  Article  Google Scholar 

  14. Harshfield GA, Hanevold C, Kapuku GK, et al.: The association of race and sex to the pressure natriuresis response to stress. Ethn Dis 2007, 17:498–302.

    PubMed  Google Scholar 

  15. Harshfield GA, Wilson ME, McLeod K, et al.: Adiposity is related to gender differences in impaired stress-induced pressure natriuresis. Hypertension 2003, 42:1082–1086.

    PubMed  Article  CAS  Google Scholar 

  16. Barbeau P, Litaker MS, Harshfield GA: Impaired pressure natriuresis in obese youths. Obes Res 2003, 11:745–751.

    PubMed  Article  Google Scholar 

  17. Friedman R, Iwai J: Genetic predisposition and stressinduced hypertension. Science 1976, 193:161–163.

    PubMed  Article  CAS  Google Scholar 

  18. Koepke JP, Copp UC, DiBona GF: The kidney in the pathogenesis of hypertension: role of the renal nerves. In The Kidney in Hypertension. Edited by Kaplan N, Brenner B, Laragh J, vol 1. New York: Raven Press; 1987:53–65.

    Google Scholar 

  19. Koepke JP, Jones S, DiBona GF: Stress increases renal nerve activity and decreases sodium excretion in Dahl rats. Hypertension 1988, 11:334–338.

    PubMed  CAS  Google Scholar 

  20. Veelken R, Hilgers KF, Stetter A, et al.: Nerve-mediated antidiuresis and antinatriuresis after air-jet stress is modulated by angiotensin II. Hypertension 1996, 28:825–832.

    PubMed  CAS  Google Scholar 

  21. Le Fevre ME, Guild SJ, Ramchandra R, et al.: Role of angiotensin II in the neural control of renal function. Hypertension 2003, 41:583–591.

    PubMed  Article  CAS  Google Scholar 

  22. Wagner C, Hinder M, Kramer BK, Kurtz A: Role of renal nerves in the stimulation of the renin system by reduced renal arterial pressure. Hypertension 1999, 34:1101–1105.

    PubMed  CAS  Google Scholar 

  23. DiBona GF: Sympathetic nervous system influences on the kidney. Role in hypertension. Am J Hypertens 1989, 2(3 Pt 2):119S–124S.

    PubMed  CAS  Google Scholar 

  24. DiBona GF: Sympathetic nervous system and the kidney in hypertension. Current opinion in nephrology and hypertension 2002, 11:197–200.

    PubMed  Article  Google Scholar 

  25. Schneider MP, Klingbeil AU, Schlaich MP, et al.: Impaired sodium excretion during mental stress in mild essential hypertension. Hypertension 2001, 37:923–927.

    PubMed  CAS  Google Scholar 

  26. Fauvel JP, Laville M, Bernard N, et al.: Effects of lisinopril on stress-induced peak blood pressure and sodium excretion: a double-blind controlled study. J Cardiovasc Pharmacol 1994, 23:227–231.

    PubMed  Article  CAS  Google Scholar 

  27. Hanevold CD, Pollock JS, Harshfield GA: Racial differences in microalbumin excretion in healthy adolescents. Hypertension 2008, 51:334–338.

    PubMed  Article  CAS  Google Scholar 

  28. Maya E, Harshfield GA, Kapuku GK: Impaired stress induced pressure natriuresis clusters with reduced endothelial function in African American youth at risk of hypertension. Presented at the International Society of Hypertension in Blacks. Atlanta, GA; June 2006; 2006:50.

  29. Kapuku G, Harshfield G, Wilson M, et al.: Impaired pressure natriuresis is associated with preclinical markers of abnormal cardiac structure and function [abstract]. Am J Hypertens 2003, 16:211A.

    Article  Google Scholar 

  30. Nesbitt SD: Hypertension in black patients: special issues and considerations. Curr Hypertens Rep 2005, 7:244–248.

    PubMed  Article  Google Scholar 

  31. Frohlich ED, Varagic J: Sodium directly impairs target organ function in hypertension. Curr Opin Cardiol 2005, 20:424–429.

    PubMed  Article  Google Scholar 

  32. Johnson RJ, Feig DI, Nakagawa T, et al.: Pathogenesis of essential hypertension: historical paradigms and modern insights. J Hypertens 2008, 26:381–391.

    PubMed  CAS  Article  Google Scholar 

  33. Koepke JP: Effect of environmental stress on neural control of renal function. Miner Electrolyte Metab 1989, 15:83–87.

    PubMed  CAS  Google Scholar 

  34. Dibona GF, Kopp UC: Neural control of renal function: Role in human hypertension. In Hypertension: Pathophysiology, Diagnosis, and Management. Edited by Laragh JH, Brenner BM, vol 1. New York: Raven Press; 1995:1349–1358.

    Google Scholar 

  35. Lawler JE, Cox RH: The borderline hypertensive rat (BHR): a new model for the study of environmental factors in the development of hypertension. Pavlov J Biol Sci 1985, 20:101–115.

    PubMed  CAS  Google Scholar 

  36. Lawler JE, Barker GF, Hubbard JW, et al.: Blood pressure and plasma renin activity response to chronic stress in the borderline hypertensive rat. Physiol Behav 1984, 32:101–105.

    PubMed  Article  CAS  Google Scholar 

  37. Anderson DE, Kearns WD, Belter WE: Progressive hypertension in dogs by avoidance conditioning and saline infusion. Hypertension 1983, 5:286–291.

    PubMed  CAS  Google Scholar 

  38. Anderson DE, Dietz JR, Murphy P: Behavioral hypertension in sodium-loaded dogs is accompanied by sustained sodium retention. J Hypertension 1986, 5:101–105.

    Article  Google Scholar 

  39. Anderson DE, Gomez-Sanchez C, Dietz JR: Suppression of renin and aldosterone in stress-salt hypertension in the dog. Am J Physiol 1986, 251:R181–R186.

    PubMed  CAS  Google Scholar 

  40. Anderson DE, Gomez-Sanchez C, Dietz JR: Suppression of plasma renin and aldosterone in stress-salt hypertension in dogs. Am J Physiol 1986, 251(1 Pt 2):R181–R186.

    Google Scholar 

  41. Wilson ME, Harshfield GA, Ortiz L, et al.: Relationship of body composition to stress-induced pressure natriuresis in youth. Am J Hypertens 2004, 17:1023–1028.

    PubMed  Article  Google Scholar 

  42. Jackson RW, Treiber FA, Harshfield GA, et al.: Urinary excretion of vasoactive factors are correlated to sodium excretion. Am J Hypertens 2001, 14:1003–1006.

    PubMed  Article  CAS  Google Scholar 

  43. Zhu H, Lu Y, Wang X, et al.: The g protein-coupled receptor kinase 4 gene modulates stress-induced sodium excretion in black normotensive adolescents. Pediatr Res 2006, 60:440–442.

    PubMed  Article  CAS  Google Scholar 

  44. Felder RA, Jose PA: Mechanisms of disease: the role of GRK4 in the etiology of essential hypertension and salt sensitivity. Nat Clin Pract Nephrol 2006, 2:637–650.

    PubMed  Article  CAS  Google Scholar 

  45. Sanada H, Yatabe J, Midorikawa S, et al.: Single-nucleotide polymorphisms for diagnosis of salt-sensitive hypertension. Clin Chem 2006, 52:352–360.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. Medical College of Georgia, MCG Annex, HS 1640, 1120 15th Street, Augusta, GA, 30912-4534, USA

    Gregory A. Harshfield

Authors
  1. Gregory A. Harshfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yanbin Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gaston K. Kapuku
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haidong Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Coral D. Hanevold
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory A. Harshfield.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Harshfield, G.A., Dong, Y., Kapuku, G.K. et al. Stress-induced sodium retention and hypertension: A review and hypothesis. Current Science Inc 11, 29 (2009). https://doi.org/10.1007/s11906-009-0007-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11906-009-0007-8

Keywords

  • Mental Stress
  • Sodium Excretion
  • African American Youth
  • Sodium Retention
  • Salt Sensitivity