Impaired sodium-dependent adaptation of arterial stiffness in formerly preeclamptic women: the RETAP-vascular study

Abstract

van der Graaf AM, Paauw ND, Toering TJ, Feelisch M, Faas MM, Sutton TR, Minnion M, Lefrandt JD, Scherjon SA, Franx A, Navis G, Lely AT. Impaired sodium-dependent adaptation of arterial stiffness in formerly preeclamptic women: the RETAP-vascular study. Am J Physiol Heart Circ Physiol 310: H1827-H1833, 2016. First published April 8, 2016; doi:10.1152/ajpheart.00010.2016.-Women with a history of preeclampsia have an increased risk for cardiovascular diseases later in life. Persistent vascular alterations in the postpartum period might contribute to this increased risk. The current study assessed arterial stiffness under low sodium (LS) and high sodium (HS) conditions in a well-characterized group of formerly early-onset preeclamptic (fPE) women and formerly pregnant (fHP) women. Eighteen fHP and 18 fPE women were studied at an average of 5 yr after pregnancy on 1 wk of LS (50 mmol Na ϩ /day) and 1 wk of HS (200 mmol Na ϩ /day) intake. Arterial stiffness was measured by pulse-wave analysis (aortic augmentation index, AIx) and carotidfemoral pulse-wave velocity (PWV). Circulating markers of the reninangiotensin aldosterone system (RAAS), extracellular volume (ECV), nitric oxide (NO), and hydrogen sulfide (H2S) were measured in an effort to identify potential mechanistic elements underlying adaptation of arterial stiffness. AIx was significantly lower in fHP women on LS compared with HS while no difference in AIx was apparent in fPE women. PWV remained unchanged upon different sodium loads in either group. Comparable sodium-dependent changes in RAAS, ECV, and NO/H2S were observed in fHP and fPE women. fPE women have an impaired ability to adapt their arterial stiffness in response to changes in sodium intake, independently of blood pressure, RAAS, ECV, and NO/H2S status. The pathways involved in impaired adaptation of arterial stiffness, and its possible contribution to the increased long-term risk for cardiovascular diseases in fPE women, remain to be investigated.Listen to this article's corresponding podcast at http://ajpheart.podbean. com/e/vascular-health-after-preeclampsia/. preeclampsia; formerly preeclamptic women; cardiovascular risk; arterial stiffness; augmentation index; sodium intake NEWS & NOTEWORTHY This study assessed arterial stiffness in healthy formerly preeclamptic (fPE) women under standardized sodium intake and shows that fPE women have a blunted response to adapt their arterial stiffness in response to low sodium intake. This phenomenon might be a first indication of an unfavorable vascular profile in fPE women.PREECLAMPSIA complicates approximately 1-5% of all pregnancies (19) and is characterized by new-onset hypertension and proteinuria or other findings such as new-onset thrombocytopenia, renal insufficiency, neurological complications, liver involvement, and fetal growth restriction during the second half of pregnancy (1). Delivery of the placenta is the only therapeutic solution and results in rapid normalization of the maternal manifestations (46). Despite normalization of hypertension a...

Sodium Intake and Hypertension

“…As in the previous study, the difference between groups in PWV was not dependent on BP levels. In a number of studies involving hypertensive patients [97,98,99,100], aortic PWV values were significantly lower in the low-salt group than in the high-salt group; however, other studies in which no significant difference in PWV has been described in relation to dietary sodium intake can be found in the literature [101,102,103,104,105,106,107]. In almost all of these latter randomized controlled trials, however, the relatively small number of enrolled patients and the relatively short duration of a given level of sodium intake with the diet assigned to each group were probably the main factors affecting the failure in reaching a statistically significant difference in PWV between high- and low-salt groups.…”

Current Data on Dietary Sodium, Arterial Structure and Function in Humans: A Systematic Review

“…Eight hundred and twenty-five (825) citations were identified through a systematic search-of which, 782 were excluded on the basis of title/abstract. The most common exclusion criteria were: language (42), duplicates-same cohort (27), different research subject (516), not original articles (191), sample size <100 subjects for observational studies only (6). Forty-three (43) articles were then assessed for eligibility and five were excluded due to irrelevant research subject and two due to different studying parameter (Na/K ratio).…”

“…Thirty-one (31) studies examining arteriosclerosis were identified-of which, 14 were observational [15][16][17][18][19][20][27][28][29][30][31][32][33][34] and 17 were interventional [22,23,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49].…”

“…From the 17 interventional studies investigating the association between arteriosclerosis [22,23,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49], seven of them showed statistically significant changes in arterial stiffness biomarkers after Na intake intervention [35,37,38,[44][45][46]49]. On the contrary, 10 out of the 17 interventional studies found no changes in arterial stiffness biomarkers with various levels of Na intake during the intervention [22,23,36,[39][40][41][42][43]47,48] ( Table 2).…”

“…In the 10 studies that found no statistically significant changes in arterial stiffness biomarkers after different levels of Na intake [22,23,36,[39][40][41][42][43]47,48], heterogeneity existed, regarding: (a) different methodologies used for arterial stiffness assessment (seven tonometry [22,23,[39][40][41][42][43], one oscillometry [35], one plethysmography [46] and one diastolic blood pressure time decay method [47]) using similar arterial stiffness biomarkers assessed (eight cfPWV [22,23,36,[39][40][41][42][43], one baPWV [46] and one arterial compliance [47]); (b) various methodologies used for Na assessment (eight 24h urine collection [22,[39][40][41][42][43]47,48] and two combination of dietary and urinary methods [18,35]); (c) different duration of intervention period and (d) different population samples (six in hypertensives [17,35,38,4...…”