Effect of Salt Supplementation on Sympathetic Activity and Endothelial Function in Salt-Sensitive Type 2 Diabetes

2019 ◽  
Vol 105 (4) ◽  
pp. e1187-e1200 ◽  
Author(s):  
Sara Baqar ◽  
Yee Wen Kong ◽  
Angela X Chen ◽  
Christopher O’Callaghan ◽  
Richard J MacIsaac ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Endothelial Function ◽  
Augmentation Index ◽  
Sodium Intake ◽  
Blood Pressure Monitoring ◽  
Muscle Sympathetic Nerve Activity ◽  
Burst Frequency ◽  
Low Sodium

Abstract Context Lower sodium intake is paradoxically associated with higher mortality in type 2 diabetes (T2D). Objective To determine whether sympathetic nervous system (SNS) activation and endothelial dysfunction contribute to these observations, we examined the effect of salt supplementation on these systems in people with T2D with habitual low sodium. We hypothesized that salt supplementation would lower SNS activity and improve endothelial function compared to placebo. Design We conducted a randomized, double-blinded, placebo-controlled crossover trial. Setting The study took place in a tertiary referral diabetes outpatient clinic. Participants Twenty-two people with T2D with habitual low sodium intake (24-hour urine sodium <150 mmol/24h) were included. Intervention Salt supplementation (100 mmol NaCl/24h) or placebo for 3 weeks was administered. Main outcome measures The primary outcome of SNS activity and endothelial function was assessed as follows: Microneurography assessed muscle sympathetic nerve activity (MSNA), pulse amplitude tonometry assessed endothelial function via reactive hyperemic index (RHI), and arterial stiffness was assessed via augmentation index (AI). Secondary outcomes included cardiac baroreflex, serum aldosterone, ambulatory blood pressure monitoring (ABPM), heart rate variability (HRV), and salt sensitivity. Results Compared to placebo, salt supplementation increased MSNA (burst frequency P = .047, burst incidence P = .016); however, RHI (P = .24), AI (P = .201), ABPM (systolic P = .09, diastolic P = .14), and HRV were unaffected. Salt supplementation improved baroreflex (slope P = .026) and lowered aldosterone (P = .004), and in salt-resistant individuals there was a trend toward improved RHI (P = .07). Conclusions In people with T2D and low habitual sodium intake, salt supplementation increased SNS activity without altering endothelial function or blood pressure but improved baroreflex function, a predictor of cardiac mortality. Salt-resistant individuals trended toward improved endothelial function with salt supplementation.

scholarly journals Comparison of endothelial function and sympathetic nervous system activity along the glucose continuum in individuals with differing metabolic risk profiles and low dietary sodium intake

2019 ◽  
Vol 7 (1) ◽  
pp. e000606 ◽  
Author(s):  
Sara Baqar ◽  
Nora E Straznicky ◽  
Gavin Lambert ◽  
Yee Wen Kong ◽  
John B Dixon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Heart Rate ◽  
Glucose Tolerance ◽  
Endothelial Function ◽  
Sodium Intake ◽  
Metabolic Risk ◽  
Low Sodium ◽  
Sympathetic Nervous

Objective: Low sodium intake may trigger sympathetic nervous system (SNS) activation and endothelial dysfunction. Studies have not explored these associations along the glucose continuum. Accordingly, we compared endothelial function and SNS activity in individuals with low sodium intake and differing categories of metabolic risk along the glucose continuum. We hypothesized that low sodium intake is associated with (1) impairment of endothelial function and (2) higher SNS activity in individuals with higher metabolic risk. Research Design and Methods: In this prospective observational study, participants (n=54) with low sodium intake (single 24 hours urine sodium excretion <150 mmol/24 hours) were categorized based on oral glucose tolerance testing as: normal glucose tolerance (NGT, n=10), impaired glucose tolerance (IGT, n=15), treatment naive type 2 diabetes (T2D−) (n=12) or treated type 2 diabetes (T2D+) (n=17). We assessed endothelial function using pulse amplitude tonometry (PAT) derived reactive hyperemic index and PAT ratio; arterial stiffness via augmentation index; muscle sympathetic nerve activity (MSNA) using microneurography; cardiac baroreflex; heart rate; blood pressure; glycosylated hemoglobin A1c (HbA1c) and lipid profile. Results: Mean (SD) sodium excretion was 110.6 (26) mmol/24 hours. Compared with NGT, IGT and T2D−, the T2D+ group had lower MSNA (p=0.005), PAT ratio (p=0.04) and baroreflex sensitivity (p=0.0002) and an augmented heart rate (p=0.02). The T2D+ group had appropriate mean (SD) glycemic (HbA1c 7.2 (1.72)%), total cholesterol (4.2 (1.0) mmol/L), low-density lipoprotein (2.2 (1.0) mmol/L) and blood pressure (systolic 136 (13), diastolic 78 (12)) (mm Hg) control. Conclusions: Individuals with T2D+ have impaired endothelial and baroreflex function, despite low sodium intake, appropriately managed cardiometabolic risk factors and lower SNS activity, compared with others along the glucose continuum. Whether low sodium intake is associated with modulation of the sympathovascular profile in T2D requires further investigation.

scholarly journals Novel Soy Germ Pasta Improves Endothelial Function, Blood Pressure, and Oxidative Stress in Patients With Type 2 Diabetes: Figure 1

Diabetes Care ◽  
2011 ◽  
Vol 34 (9) ◽  
pp. 1946-1948 ◽  
Author(s):  
Carlo Clerici ◽  
Elisabetta Nardi ◽  
Pier Maria Battezzati ◽  
Stefania Asciutti ◽  
Danilo Castellani ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Endothelial Function ◽  
And Oxidative Stress

scholarly journals The effect of OMEGA-3 polyunsaturated fatty acids on ambulatory blood pressure monitoring parameters in patients with type 2 diabetes mellitus and cardiovascular autonomic neuropathy

2019 ◽  
Vol 22 (1) ◽  
pp. 62-69
Author(s):  
Victoria A. Serhiyenko ◽  
Boris N. Mankovsky ◽  
Ludmila М. Serhiyenko ◽  
Aleksandr A. Serhiyenko
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Fatty Acids ◽  
Type 2 Diabetes Mellitus ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Time Index

Background: Cardiovascular autonomic neuropathy (CAN) in type 2 diabetes mellitus (T2DM), which is characterized by lesion of nerve fibers in parasympathetic and sympathetic nervous system is one of the leading causes of heart arrhythmias and an independent risk factor for cardiovascular mortality in patients with T2DM. Therefore, the problem of effective treatment of CAN is particularly relevant. Aims: To analyze the effect of long-chain polyunsaturated fatty acids (-3 PUFAs) on ambulatory blood pressure monitoring parameters in patients with T2DM and CAN. Materials and methods: 36 patients with T2DM and confirmed CAN were divided into two groups. First group received hypoglycemic therapy (n=15, control) for three months; patients in group 2 (n=21) in addition were administered 1 capsule/q.d. of -3 PUFAs for three month. Results: Treatment with -3 PUFAs led to significant decrease of the diastolic blood pressure (DBP) (p0,01), diastolic blood pressure load (p0,05), time index of DBP (p0,05) during the day; DBP (p0,05), diastolic blood pressure load (p0,05), time index of DBP (p0,05), SD DBP (p0,01) during the night (compared to the control group). Conclusions: The study showed that prescription of -3 PUFAs for three month was effective in decreasing diastolic blood pressure and its parameters among patients with T2DM and CAN.

scholarly journals Efficacy of single-dose cholecalciferol in the blood pressure of patients with type 2 diabetes, hypertension and hypovitaminoses D

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Tatiana P. de Paula ◽  
Juliano S. R. Moreira ◽  
Luiza F. Sperb ◽  
Maria Elisa P. Muller ◽  
Thais Steemburgo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Vitamin D ◽  
Single Dose ◽  
Blood Pressure Monitoring ◽  
Hypovitaminosis D ◽  
Vitamin D Insufficiency ◽  
Vitamin D Supplementation ◽  
Before And After

AbstractObservational and experimental data reinforce the concept that vitamin D is associated with the pathogenesis of arterial hypertension. We investigated the effect of a single dose of 100,000 IU of cholecalciferol, in office blood pressure (BP), and 24-h ambulatory blood pressure monitoring (ABPM) in patients with type 2 diabetes mellitus (DM), hypertension, and hypovitaminosis D. Forty-three patients were randomized to a placebo or cholecalciferol group. BP was assessed by office measurements and 24-h ABPM, before and after intervention. At week 8, a greater decrease in median ABPM values was observed in cholecalciferol supplementation than in the placebo group for systolic 24-h (− 7.5 vs. − 1; P = 0.02), systolic daytime (− 7 vs. − 1; P = 0.007), systolic nighttime (− 7.0 vs. 3; P = 0.009), diastolic 24-h (− 3.5 vs. − 1; P = 0.037), and daytime DBP (− 5 vs. 0; P = 0.01). Office DBP was also reduced after vitamin D supplementation. A single dose of vitamin D3 improves BP in patients with type 2 diabetes, hypertension, and vitamin D insufficiency, regardless of vitamin D normalization. Vitamin D supplementation could be a valuable tool to treat patients with type 2 DM, hypertension, and hypovitaminosis D.Trial registration: Clinicaltrials.gov NCT 02204527.

scholarly journals Awaking Blood Pressure Surge and Progression to Microalbuminuria in Type 2 Normotensive Diabetic Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Michelangela Barbieri ◽  
Maria Rosaria Rizzo ◽  
Ilaria Fava ◽  
Celestino Sardu ◽  
Nicola Angelico ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cox Regression ◽  
Blood Pressure Monitoring ◽  
Adult Patients ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Pressure Surge

Background. We investigated the predictive value of morning blood pressure surge (MBPS) on the development of microalbuminuria in normotensive adults with a recent diagnosis of type 2 diabetes.Methods. Prospective assessments of 24-hour ambulatory blood pressure monitoring and urinary albumin excretion were performed in 377 adult patients. Multivariate-adjusted Cox regression models were used to assess hazard ratios (HRs) between baseline and changes over follow-up in MBPS and the risk of microalbuminuria. The MBPS was calculated as follows: mean systolic BP during the 2 hours after awakening minus mean systolic BP during the 1 hour that included the lowest sleep BP.Results. After a mean follow-up of 6.5 years, microalbuminuria developed in 102 patients. An increase in MBPB during follow-up was associated with an increased risk of microalbuminuria. Compared to individuals in the lowest tertile (−0.67±1.10 mmHg), the HR and 95% CI for microalbuminuria in those in the highest tertile of change (24.86±6.92 mmHg) during follow-up were 17.41 (95% CI 6.26–48.42);pfor trend <0.001. Mean SD MBPS significantly increased in those who developed microalbuminuria from a mean [SD] of 10.6[1.4]to 36.8[7.1],p<0.001.Conclusion. An increase in MBPS is associated with the risk of microalbuminuria in normotensive adult patients with type 2 diabetes.

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