Impaired sodium excretion during mental stress in mild essential hypertension

In hypertensive rats, environmental stress causes sodium retention by an exaggerated increase in renal sympathetic nerve activity, which is modulated by angiotensin II. We tested whether similar effects can be observed in humans. In 66 normotensive subjects (half of them with a family history of hypertension) and 36 subjects with mild essential hypertension, urinary sodium excretion and renal hemodynamics were examined at rest and during mental stress treated either with placebo or ACE inhibition in a double-blind, randomized, cross-over design. Despite a marked increase in glomerular filtration rate in response to mental stress (Δ glomerular filtration rate, 4.3±7.7 mL/min in normotensives without versus 5.6±8.4 mL/min in normotensives with a family history versus 10.1±5.7 mL/min in patients with mild essential hypertension; P<0.002), the increase in urinary sodium excretion was blunted in patients with mild essential hypertension (Δ urinary sodium excretion, 0.12±0.17 mmol/min versus 0.10±0.14 mmol/min versus 0.05±0.14 mmol/min; P<0.05). ACE inhibition corrected the natriuretic response to mental stress in subjects with mild essential hypertension (Δ urinary sodium excretion, 0.05±0.14 mmol/min with placebo versus 0.13±0.19 mmol/min with ACE inhibition; P<0.01); thus, after ACE inhibition, urinary sodium excretion increased similarly in all 3 groups. In conclusion, impaired sodium excretion occurs during mental stress in human essential hypertension but not in subjects with positive family history of hypertension. This abnormality in sodium handling during activation of the sympathetic nervous system appears to be mediated by angiotensin II.