From Micro- to Macro-vessels : Water, Salt, Heart and Kidneys
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 72
- Locations
- 1
- Primary Endpoint
- CF-PWV
Study Overview
Brief Summary
Hypertension is a public health concern and affects nearly a third of the French population. It can be complicated by visceral impact (including brain, heart and kidney complications) as well as on vessels especially large arteries, responsible for arterial stiffening. There are close interactions between heart and kidneys, as well as between large arteries and micro-vessels. These relationships also involve the water and salt balance and its regulatory mechanisms. Urinary concentration abilities are closely linked to the renal medullary blood flow, which in itself depends on the integrity of renal micro vessels, thus influencing the water and salt balance. Few previous studies evaluated the interconnections between renal urinary concentration abilities and blood pressure. A previous-one reported a positive relation between pulse pressure and urinary concentration in men, suggesting that subjects with higher urinary osmolarity could present a higher cardiovascular risk. Carotid-femoral pulse wave velocity represents the gold standard for non-invasive arterial stiffness assessment and constitutes an arteriosclerosis infra-clinical marker recommended by the European Society of Cardiology- European Society of Hypertension. It is considered as an independent predictor for global and cardiovascular mortality, coronary heart disease and fatal stroke among patients with hypertension, diabetes or end stage kidney disease. The purpose of this study is to evaluate the relations between fasting urinary osmolarity and arterial stiffness assessed by carotid-femoral pulse wave velocity (CF-PWV) among patients with hypertension.
Detailed Description
-
Hypertension
-
Hypertension, kidneys et urinary sodium excretion
Kidneys are heavily involved in blood pressure regulation in particular through water and salt balance control, and their impact on vasomotor tone through the renin-angiotensin aldosterone system (RAAS), prostaglandins or atrial natriuretic factor (FAN) actions. They take a central place in blood pressure regulation and indirectly in arterial stiffening.
Daily urinary sodium excretion represents a major determinant of blood pressure. It is defined as the product of urinary sodium concentration and urinary output. In a steady state, it equals sodium intake. When kidneys are unable to excrete sodium, blood volume and blood pressure increase. The result is an adaptive decrease in sodium reabsorption (called "pressure natriuresis"), in order to restore the sodium balance. "Salt sensitivity" has been defined as a significant increase in blood pressure associated with the increase sodium intake. It has been associated with age, ethnicity, obesity, metabolic syndrome, and chronic kidney disease (CKD). Chronic kidney disease is frequently associated with salt and fluid retention, which promote hypertension and increase cardiovascular risk.
Among dialysis patients, fluid overload has been widely described as an independent mortality risk factor. Recently, Faucon et al. reported in the nephroTEST cohort of CKD patients not yet on dialysis that the measured extra cellular volume (ECV) was an independent risk factor for mortality but also for CKD progression to the end stage of kidney disease. Reduced sodium excretion abilities associated with CKD progression lead to fluid overload and cardiac consequences. The increase of left ventricular preload promotes diastolic dysfunction. In parallel, the prolonged increase of left ventricular afterload promotes left ventricular hypertrophy. Other CKD associated factors could also contribute to left ventricular hypertrophy such as the increased arterial stiffness, and CKD-mineral and bone disorders including the raise of FGF-23. 2. Nephron, water and salt balance regulation, and outside of the glomerulus
Study Design
- Study Type
- Observational
- Observational Model
- Cohort
- Time Perspective
- Prospective
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Adults patients
- •Day hospitalization for a check-up in the context of arterial hypertension with suspicion of secondary origin including a dosage of renin and plasma aldosterone
- •Non-opposition to the study
Exclusion Criteria
- •Cardiac arrythmia
- •Patient under AME (state medical assistance)
- •Treatments interfering with uninterrupted hormonal dosages before day hospitalization
- •Absence of B-blockers, converting enzyme inhibitor and sartans in the 15 days preceding the dosages
- •Absence of antialdosterone, and amiloride in the 6 weeks preceding the dosages
- •Absence of loop diuretics or diuretics in the 7 days preceding the dosages
Outcomes
Primary Outcomes
CF-PWV
Time Frame: Inclusion
Carotid-femoral pulse wave velocity
Secondary Outcomes
- PRA(Inclusion)
- Nocturnal dipping percentage of systolic blood pressure(Inclusion)
- Primary hyperaldosteronism(Inclusion)
- Ankle-brachial pressure index (ABPI)(Inclusion)
- Smoking status(Inclusion)