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Br Med J (Clin Res Ed). 1981 August 15; 283(6289): 463–468.
PMCID: PMC1506255

Sodium and potassium in essential hypertension.


A study was carried out of arterial pressure and body content of electrolytes in 91 patients with essential hypertension and 121 normal controls. Exchangeable sodium was found to be positively correlated with arterial pressure in the patients, the correlation being closest in older patients; values of exchangeable sodium were subnormal in young patients; and plasma, exchangeable, and total body potassium correlated inversely with arterial pressure in the patients, the correlations being closest in young patients. Three hypotheses were proposed to explain the mechanisms relating electrolytes and arterial pressure in essential hypertension--namely, a cell-salt hypothesis, a dietary salt hypothesis, and a kidney-salt hypothesis. It was concluded that two mechanisms probably operate in essential hypertension. In the early stages of the disease blood pressure is raised by an abnormal process related more closely to potassium than to sodium. A renal lesion develops later, possibly as a consequence of the hypertension. This lesion is characterised by resetting of pressure natriuresis and is manifest by an abnormal relation between body sodium and arterial pressure and by susceptibility to increased dietary sodium intake.

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  • Guyton AC, Coleman TG, Cowley AV, Jr, Scheel KW, Manning RD, Jr, Norman RA., Jr Arterial pressure regulation. Overriding dominance of the kidneys in long-term regulation and in hypertension. Am J Med. 1972 May;52(5):584–594. [PubMed]
  • BORST JG, BORST-DE GEUS A. Hypertension explained by Starling's theory of circulatory homoeostasis. Lancet. 1963 Mar 30;1(7283):677–682. [PubMed]
  • Ledingham JM. The etiology of hypertension. Practitioner. 1971 Jul;207(237):5–19. [PubMed]
  • Brown JJ, Lever AF, Robertson JI. Pathogenesis of essential hypertension. Lancet. 1976 Jun 5;1(7971):1217–1219. [PubMed]
  • LOSSE H, WEHMEYER H, WESSELS F. [The water- and electrolyte content of erythrocytes in arterial hypertension]. Klin Wochenschr. 1960 Apr 15;38:393–395. [PubMed]
  • Edmondson RP, Thomas RD, Hilton PJ, Patrick J, Jones NF. Abnormal leucocyte composition and sodium transport in essential hypertension. Lancet. 1975 May 3;1(7914):1003–1005. [PubMed]
  • Wambach G, Helber A, Bönner G, Hummerich W. Natrium-Kalium--Adenosintriphosphatase-Aktivität in Erythrozytenghosts von Patienten mit essentielier Hypertonie. Klin Wochenschr. 1979 Feb 15;57(4):169–172. [PubMed]
  • Haddy F, Pamnani M, Clough D. The sodium-potassium pump in volume expanded hypertension. Clin Exp Hypertens. 1978;1(3):295–336. [PubMed]
  • de Wardener HE, MacGregor GA. Dahl's hypothesis that a saluretic substance may be responsible for a sustained rise in arterial pressure: its possible role in essential hypertension. Kidney Int. 1980 Jul;18(1):1–9. [PubMed]
  • Boddy K, Brown JJ, Davies DL, Elliott A, Harvey I, Haywood JK, Holloway I, Lever AF, Robertson JI, Williams ED. Concurrent estimation of total body and exchangeable body sodium in hypertension. Clin Sci Mol Med. 1978 Feb;54(2):187–191. [PubMed]
  • Dathan JR, Johnson DB, Goodwin FJ. The relationship between body fluid compartment volumes, renin activity and blood pressure in chronic renal failure. Clin Sci. 1973 Jul;45(1):77–88. [PubMed]
  • Davies DL, Beevers DG, Briggs JD, Medina AM, Robertson JI, Schalekamp MA, Brown JJ, Lever AF, Morton JJ, Tree M. Abnormal relation between exchangeable sodium and the renin-angiotensin system in malignant hypertension and in hypertension with chronic renal failure. Lancet. 1973 Mar 31;1(7805):683–686. [PubMed]
  • Safar ME, London GM, Weiss YA, Milliez PL. Overhydratation and renin in hypertensive patients with terminal renal failure: a hemodynamic study. Clin Nephrol. 1975 Nov;4(5):183–188. [PubMed]
  • Beretta-Piccoli C, Weidmann P, De Châtel R, Reubi F. Hypertension associated with early stage kidney disease. Complementary roles of circulating renin, the body sodium/volume state and duration of hypertension. Am J Med. 1976 Nov;61(5):739–747. [PubMed]
  • Ferriss JB, Beevers DG, Boddy K, Brown JJ, Davies DL, Fraser R, Kremer D, Lever AF, Robertson JI. The treatment of low-renin ("primary") hyperaldosteronism. Am Heart J. 1978 Jul;96(1):97–109. [PubMed]
  • Bianchi G, Ponticelli C, Bardi U, Redaelli B, Campolo L, De Ponti C, Graziani G. Role of the kidney in 'salt and water dependent hypertension' of end-stage disease. Clin Sci. 1972 Jan;42(1):47–55. [PubMed]
  • DE GRAEFF J. Inulin space and total exchangeable sodium in patients with essential hypertension. Acta Med Scand. 1957 Jan 15;156(5):337–350. [PubMed]
  • HOLLANDER W, CHOBANIAN AV, BURROWS BA. Body fluid and electrolyte composition in arterial hypertension. I. Studies in essential, renal and malignant hypertension. J Clin Invest. 1961 Feb;40:408–415. [PMC free article] [PubMed]
  • Woods JW, Liddle GW, Michelakis AM, Brill AB. Effect of an adrenal inhibitor in hypertensive patients with suppressed renin. Arch Intern Med. 1969 Apr;123(4):366–370. [PubMed]
  • Lebel M, Schalekamp MA, Beevers DG, Brown JJ, Davies DL, Fraser R, Kremer D, Lever AF, Morton JJ, Robertson JI, et al. Sodium and the renin-angiotensin system in essential hypertension and mineralocorticoid excess. Lancet. 1974 Aug 10;2(7876):308–309. [PubMed]
  • TOBIAN L, JANECEK J, TOMBOULIAN A, FERREIRA D. Sodium and potassium in the walls of arterioles in experimental renal hypertension. J Clin Invest. 1961 Oct;40:1922–1925. [PMC free article] [PubMed]
  • Garay RP, Dagher G, Pernollet MG, Devynck MA, Meyer P. Inherited defect in a Na+, K-co-transport system in erythrocytes from essential hypertensive patients. Nature. 1980 Mar 20;284(5753):281–283. [PubMed]
  • Canessa M, Adragna N, Solomon HS, Connolly TM, Tosteson DC. Increased sodium-lithium countertransport in red cells of patients with essential hypertension. N Engl J Med. 1980 Apr 3;302(14):772–776. [PubMed]
  • Freis ED. Salt, volume and the prevention of hypertension. Circulation. 1976 Apr;53(4):589–595. [PubMed]
  • Tobian L, Lange J, Iwai J, Hiller K, Johnson MA, Goossens P. Prevention with thiazide of NaCl-induced hypertension in Dahl "S" rats. Evidence for a Na-retaining humoral agent in "S" rats. Hypertension. 1979 May-Jun;1(3):316–323. [PubMed]
  • Brown WJ, Jr, Brown FK, Krishan I. Exchangeable sodium and blood volume in normotensive and hypertensive humans on high and low sodium intake. Circulation. 1971 Apr;43(4):508–519. [PubMed]
  • Sullivan JM, Ratts TE, Taylor JC, Kraus DH, Barton BR, Patrick DR, Reed SW. Hemodynamic effects of dietary sodium in man: a preliminary report. Hypertension. 1980 Jul-Aug;2(4):506–514. [PubMed]
  • Parfrey PS, Condon K, Wright P, Vandenburg MJ, Holly JM, Goodwin FJ, Evans SJ, Ledingham JM. Blood pressure and hormonal changes following alteration in dietary sodium and potassium in young men with and without a familial predisposition to hypertension. Lancet. 1981 Jan 17;1(8212):113–117. [PubMed]
  • Luft FC, Rankin LI, Bloch R, Weyman AE, Willis LR, Murray RH, Grim CE, Weinberger MH. Cardiovascular and humoral responses to extremes of sodium intake in normal black and white men. Circulation. 1979 Sep;60(3):697–706. [PubMed]
  • Parfrey PS, Vandenburg MJ, Wright P, Holly JM, Goodwin FJ, Evans SJ, Ledingham JM. Blood pressure and hormonal changes following alteration in dietary sodium and potassium in mild essential hypertension. Lancet. 1981 Jan 10;1(8211):59–63. [PubMed]
  • Kawasaki T, Delea CS, Bartter FC, Smith H. The effect of high-sodium and low-sodium intakes on blood pressure and other related variables in human subjects with idiopathic hypertension. Am J Med. 1978 Feb;64(2):193–198. [PubMed]
  • Fujita T, Henry WL, Bartter FC, Lake CR, Delea CS. Factors influencing blood pressure in salt-sensitive patients with hypertension. Am J Med. 1980 Sep;69(3):334–344. [PubMed]
  • Tobian L, Johnson MA, Lange J, Magraw S. Effect of varying perfusion pressures on the output of sodium and renin and the vascular resistance in kidneys of rats with "post-salt" hypertension and Kyoto spontaneous hypertension. Circ Res. 1975 Jun;36(6 Suppl 1):162–170. [PubMed]
  • Thompson JM, Dickinson CJ. The relation between the excretion of sodium and water and the perfusion pressure in the isolated, blood-perfused, rabbit kidney, with special reference to changes occurring in clip-hypertension. Clin Sci Mol Med. 1976 Mar;50(3):223–236. [PubMed]
  • Girardin E, Caverzasio J, Iwai J, Bonjour JP, Muller AF, Grandchamp A. Pressure natriuresis in isolated kidneys from hypertension-prone and hypertension-resistant rats (Dahl rats). Kidney Int. 1980 Jul;18(1):10–19. [PubMed]
  • Lowenstein J, Beranbaum ER, Chasis H, Baldwin DS. Intrarenal pressure and exaggerated natriuresis in essential hypertension. Clin Sci. 1970 Mar;38(3):359–374. [PubMed]
  • Willassen Y, Ofstad J. Renal sodium excretion and the peritubular capillary physical factors in essential hypertension. Hypertension. 1980 Nov-Dec;2(6):771–779. [PubMed]
  • Birkenhäger WH, Schalekamp MA, Krauss XH, Kolsters G, Schalekamp-Kuyken MP, Kroon BJ, Teulings FA. Systemic and renal haemodynamics, body fluids and renin in benign essential hypertension with special reference to natural history. Eur J Clin Invest. 1972 Jan;2(2):115–122. [PubMed]
  • Reubi FC, Weidmann P. Relationships between sodium clearance, plasma renin activity, plasma aldosterone, renal hemodynamics and blood pressure in essential hypertension. Clin Exp Hypertens. 1980;2(3-4):593–612. [PubMed]
  • Dahl LK, Leitl G, Heine M. Influence of dietary potassium and sodium/potassium molar ratios on the development of salt hypertension. J Exp Med. 1972 Aug 1;136(2):318–330. [PMC free article] [PubMed]
  • Overbeck HW, Derifield RS, Pamnani MB, Sözen T. Attenuated vasodilator responses to K+ in essential hypertensive men. J Clin Invest. 1974 Mar;53(3):678–686. [PMC free article] [PubMed]
  • Barraclough MA. Sodium and water depletion with acute malignant hypertension. Am J Med. 1966 Feb;40(2):265–272. [PubMed]
  • Atkinson AB, Davies DL, Leckie B, Morton JJ, Brown JJ, Fraser R, Lever AF, Robertson JI. Hyponatraemic hypertensive syndrome with renal-artery occlusion corrected by captopril. Lancet. 1979 Sep 22;2(8143):606–609. [PubMed]

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