Adverse cardiac effects of salt with fludrocortisone in hypertension

Pitt O. Lim, Colin A. J. Farquharson, Paul Shiels, Roland T. Jung, Allan D. Struthers, Thomas M. MacDonald

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    38 Citations (Scopus)

    Abstract

    The effect of salt on blood pressure (BP) is controversial. A more important question is whether salt can produce cardiac target-organ damage, irrespective of its effect on BP. We assessed the effect of salt with fludrocortisone on QT dispersion and echocardiographic left ventricular diastolic function in a prospective interventional study involving 29 hypertensive subjects with a raised aldosterone/renin ratio who were hospitalized for investigation of possible primary aldosteronism. Each subject over 4 days was given a total of 28.8 g (480 mmol) of sodium chloride and 1.5 mg of fludrocortisone with potassium supplementation. Baseline and posttreatment 12-lead ECGs and echocardiograms were obtained. There were no significant changes in body weight, pulse rate, or BP after treatment with salt and fludrocortisone. Plasma sodium was significantly increased from 141.4 (SD 2.1) to 142.6 (SD 2.4) mmol/L (P=0.001). QT and QTc dispersion both significantly increased: +19.6 (SD 16.5) ms (95% CI, 13.4 to 25.9) (P<0.001) and +19.8 (SD 20.9) ms (95% CI, 11.8 to 27.7) (P<0.001), respectively. There were no significant changes in (n=15) left ventricular dimensions or systolic function, but all diastolic filling indexes, including the preload-independent index, flow propagation velocity (55.49 [SD 10.91] to 48.96 [SD 11.40] cm/s, P=0.018) worsened, suggesting significant deterioration of left ventricular diastolic function with salt and fludrocortisone. In conclusion, a combination of salt with fludrocortisone increased QT dispersion and impaired left ventricular diastolic relaxation in hypertensive patients with high aldosterone/renin ratios. This raises the possibility that salt may have BP-independent adverse cardiac effects in susceptible hypertensive subjects.
    Original languageEnglish
    Pages (from-to)856-861
    Number of pages6
    JournalHypertension
    Volume37
    Issue number3
    DOIs
    Publication statusPublished - Mar 2001

    Keywords

    • Sodium
    • Fludrocortisone
    • Hypertension
    • QT dispersion
    • Diastole

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