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Randomized Controlled Trial
. 2022 Apr 19;11(8):e022723.
doi: 10.1161/JAHA.121.022723. Epub 2022 Apr 18.

Tissue Sodium in Patients With Early Stage Hypertension: A Randomized Controlled Trial

Aseel Alsouqi  1   2 , Serpil Muge Deger  3 , Melis Sahinoz  2 , Cindy Mambungu  4 , Adrienne R Clagett  4 , Aihua Bian  5 , Andrew Guide  5 , Thomas G Stewart  5 , Mindy Pike  6 , Cassianne Robinson-Cohen  4 , Rachelle Crescenzi  7 , Meena S Madhur  8   9 , David G Harrison  8 , Talat Alp Ikizler  4
Affiliations
Randomized Controlled Trial

Tissue Sodium in Patients With Early Stage Hypertension: A Randomized Controlled Trial

Aseel Alsouqi et al. J Am Heart Assoc. .

Abstract

Background Sodium (Na+) stored in skin and muscle tissue is associated with essential hypertension. Sodium magnetic resonance imaging is a validated method of quantifying tissue stores of Na+. In this study, we evaluated tissue Na+ in patients with elevated blood pressure or stage I hypertension in response to diuretic therapy or low Na+ diet. Methods and Results In a double-blinded, placebo-controlled trial, patients with systolic blood pressure 120 to 139 mm Hg were randomized to low sodium diet (<2 g of sodium), chlorthalidone, spironolactone, or placebo for 8 weeks. Muscle and skin Na+ using sodium magnetic resonance imaging and pulse wave velocity were assessed at the beginning and end of the study. Ninety-eight patients were enrolled to undergo baseline measurements and 54 completed randomization. Median baseline muscle and skin Na+ in 98 patients were 16.4 mmol/L (14.9, 18.9) and 13.1 mmol/L (11.1, 16.1), respectively. After 8 weeks, muscle Na+ increased in the diet and chlorthalidone arms compared with placebo. Skin sodium was decreased only in the diet arm compared with placebo. These associations remained significant after adjustment for age, sex, body mass index, systolic blood pressure, and urinary sodium. No changes were observed in pulse wave velocity among the different groups when compared with placebo. Conclusions Diuretic therapy for 8 weeks did not decrease muscle or skin sodium or improve pulse wave velocity in patients with elevated blood pressure or stage I hypertension. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02236520.

Keywords: diuretics; hypertension; prehypertension; salt intake; sodium; sodium MRI; tissue sodium.

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Figures

Figure 1
Figure 1. Outline of study procedures.
BP indicates blood pressure 23NaMRI, 23Na magnetic resonance imaging; and PWV, pulse wave velocity.
Figure 2
Figure 2. Patient enrollment, randomization, and completion (CONSORT) flow diagram.
MRI indicates magnetic resonance imaging; and PWV, pulse wave velocity.
Figure 3
Figure 3. Strip plot of muscle sodium and skin sodium concentrations by race.
Figure 4
Figure 4. Baseline pulse wave velocity measurements by race.
See this image and copyright information in PMC

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