Blood pressure is linked to salt intake and modulated by the angiotensinogen gene in normotensive and hypertensive elderly subjects

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ObjectivesTo evaluate salt sensitivity in elderly subjects with different forms of hypertension and controls and to investigate any modulation by genotypeDesignRandomized, double-blinded, placebo-controlled latin-squareSettingTertiary referral hospitalParticipantsCommunity subjects (n = 46) aged 60 years classified as isolated systolic hypertension [ISH; systolic blood pressure (SBP) 160, diastolic blood pressure (DBP) < 90 mmHg, n = 19], diastolic ± systolic hypertension (SDH; DBP 90 mmHg, n = 10) and normotension (SBP < 160, DBP < 90 mmHg, n = 17).InterventionFour 14 day treatments, 50, 100, 200 and 300 mmol/day of sodium chloride supplementation interspersed with 14 day washout periods on a salt-restricted diet.Main outcome measuresThe 24 h blood pressure, heart rate, weight, urinary sodium and creatinine clearance measured during baseline, treatment and washout periods and angiotensinogen (AGT) and angiotensin converting enzyme (ACE) genotypes.ResultsFor the entire cohort, the mean ± standard error (SE) of change from baseline in SBP for 50, 100, 200 and 300 mmol/day salt was 7.7 ± 2.4, 12.1 ± 2.4, 16.6 ± 3.0, 18.5 ± 2.6 mmHg, respectively. For DBP, the respective changes were: 0.1 ± 1.5, 2.4 ± 1.6, 3.0 ± 1.5, 5.8 ± 1.7 mmHg. The increase in SBP among ISH subjects was significantly higher than among subjects in the SDH and normotensive groups (P< 0.05). AGT genotype influenced the effect of salt dose on the change in DBP (P = 0.006) but not SBP (P = 0.7).ConclusionsIn healthy, older subjects, a linear increase in BP occurred with increasing salt dose, it appeared most pronounced in ISH subjects and could be modulated by AGT genotype.

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