Pathogenesis of Higher Blood Pressure and Worse Renal Function in Salt-Sensitive Hypertension

• Published in: Kidney & blood pressure research Vol. 46; no. 2; pp. 236 - 244
• Main Authors: Chu, Yuguang, Zhou, Yan, Lu, Shihua, Lu, Feng, Hu, Yuanhui
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.04.2021; Karger Publishers
• Subjects: 1-Phosphatidylinositol 3-kinase; AKT protein; ambulatory blood pressure; Blood pressure; Cell proliferation; Damage; Glomerular filtration rate; growth factor; Growth factors; Health care; Hospitals; Hypertension; Immune system; Insulin-like growth factor-binding protein 2; Insulin-like growth factor-binding protein 3; Insulin-like growth factor-binding protein 6; Lymphatic system; Medical research; Mortality; Neurotrophin 4; Pathogenesis; Patients; pi3k-akt signaling pathway; Platelet-derived growth factor; Population; Proteins; renal damage; Renal function; Research Article; Salt; salt-sensitive hypertension; Salts; Software; Statistical analysis; Traditional Chinese medicine; Vascular endothelial growth factor; Vascular endothelial growth factor receptors; Water circulation; China; Ambulatory blood pressure; Salt-sensitive hypertension; Renal damage; PI3K-AKT signaling pathway; Growth factor
• ISSN: 1420-4096; 1423-0143; 1423-0143
• DOI: 10.1159/000515088

Background: The underlying pathogenesis of patients with salt-sensitive hypertension expressing higher blood pressure and severer renal damage remains uncertain. Methods: We recruited 329 subjects, 131 in salt-sensitive (SS) group, 148 in nonsalt-sensitive (NSS) group, and 50 healthy people in normal group and tested their renal function, 24-h ambulatory blood pressure, and growth factor series. Results: The SS group showed worse renal function with lower estimated glomerular filtration rate and higher urinary microalbumin, α-microglobulin, urinary protein Cr ratio, and urinary immunoglobulin. Most indicators in 24-h ambulatory blood pressure of the SS group were significantly enhanced than the NSS group, indicating their higher blood pressure. The significantly elevated growth factors in the SS group were AR, BMP-5, EG-VEGF, GH, HGF, IGFBP-2, IGFBP-3, IGFBP-6, MCSFR, NT-4, PDGF-AA, SCF, SCFR, VEGFR2, VEGFR3, and VEGF-D, compared to other 2 groups or one of them. PI3K-AKT pathway was activated in the SS group. Conclusions: Differences in growth factors and pathways may account for the manifestations of the SS group. Activated PI3K-AKT pathway with higher IGFBP-3 and GH can lead to renal damage. Higher MCSFR in the SS group indicates that high blood pressure and severe kidney damage may be associated with the activation of the immune system. EG-VEGF, VEGFR2, VEGFR3, and VEGF-D can also explain the elevated blood pressure due to the dilated lymphatic system which drains excess sodium and water back into circulation. The SS group presented higher AR and HGF which may worsen renal function by regulating cell proliferation and tumor formation. However, due to the potential low awareness rate of hypertension at the very beginning, we cannot ensure the exact occurrence order of blood pressure, renal damage, and salt sensitivity. Therefore, further studies which can track data from the onset of hypertension are needed.