Renal mechanisms contributing to blood pressure and the development of salt-sensitive hypertension
Puleo, Franco Jimmy
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High blood pressure or hypertension is a major public health issue that affects more than 50% of adults in the United States. Hypertension is the leading risk factor for multiple cardiovascular events including stroke and myocardial infarction. In general, hypertension is considered a disease of the aged population as 2/3rds of adults over 65 are hypertensive. Critically, a sex dependent component exists as females under age 50 are less likely to develop hypertension than males. Dietary sodium intake significantly influences blood pressure regulation and its importance is underscored by the salt-sensitivity of blood pressure, which is characterized by acute increases in blood pressure in response to dietary salt intake. The salt-sensitivity of blood pressure is prevalent in 25% of normotensive individuals and 50% of hypertensive individuals. Coupled with statistics that show Americans on average consume 2 g of sodium in excess of the recommended daily allowance, the risk for developing salt-sensitive hypertension is drastically higher in salt-sensitive individuals. Moreover with age, there is an increase in the prevalence and severity of salt-sensitivity. Taken together, these findings underscore the need for novel therapeutics to combat hypertension. The pathophysiology of the salt-sensitivity of blood pressure and age dependent hypertension has been attributed in part to excessive sympathetic outflow that can drive increases in sodium reabsorption. Excessive sympathetic outflow via the release of norepinephrine has been linked to increased activity of a key renal sodium transporter, the sodium chloride cotransporter (NCC). This thesis investigates the adrenergic signaling pathway by which excessive sympathetic outflow drives NCC activity and sodium reabsorption as well investigates the mechanisms underlying sex differences in age dependent hypertension. Our findings demonstrate that 1) norepinephrine mediates its influence on NCC activity via an α1-adrenoceptor gated pathway involving WNK/SPAK/OxSR1 kinase signaling, 2) α1-adrenoceptor antagonism can prevent and attenuate the development and maintenance of salt-sensitive hypertension, 3) β-adrencoptor antagonism has no effect on NCC activity, 4) in male rats age dependent salt-sensitivity of blood pressure and hypertension is associated with age dependent- increases in NCC activity and impairments in renal sodium handling, and 5) female rats do not develop age dependent hypertension or salt-sensitivity of blood pressure. Collectively, these results support a sympathetic model of NCC regulation that plays a key role in salt-sensitive hypertension and age dependent hypertension.