Sodium and water balance in chronic congestive heart failure.
Open Access
- 1 May 1986
- journal article
- research article
- Published by American Society for Clinical Investigation in Journal of Clinical Investigation
- Vol. 77 (5) , 1441-1452
- https://doi.org/10.1172/jci112456
Abstract
As the characteristics of sodium and water balance in heart failure remain undefined, we evaluated the hemodynamic, metabolic, and hormonal effects of balanced sodium intake in 10 patients with chronic congestive heart failure. We discontinued diuretics to avoid their confounding influence, and all patients received 1 wk of 10 meq and 100 meq balanced sodium intake and controlled free water. Comparing sodium intake of 10 with 100 meq, the following observations were made. There was weight gain (2.0 kg) and increased sodium excretion (11 +/- 3 to 63 +/- 15 meq/24 h), unaccompanied by increase of blood volume. Both renin-angiotensin system and sympathetic nervous system activity were greater during the 10 meq diet, and suppressed with the 100 meq sodium diet. For both diets, plasma renin and urinary aldosterone excretion were correlated with urinary sodium excretion (r = -0.768, r = -0.726, respectively; P less than 0.005). Systemic hemodynamics were minimally changed with increased sodium intake. However, reversal of vasoconstriction by captopril during the 10 meq diet, and its ineffectiveness during the 100 meq diet, indicated a renin-dependent mechanism in the former, and a renin-independent mechanism in the latter diet. There were two subgroups of response to the 100 meq diet: one group (n = 5) achieved neutral balance, while the second (n = 5) avidly retained sodium and water. Renin-angiotensin system activity was significantly higher in the latter group, and the mechanism for differences in sodium excretion for the subgroups could not be identified by blood volume or hemodynamic parameters. Orthostatic hypotension during tilt was greater during the 10 meq sodium diet, and in all cases, related to ineffective hemodynamic and hormonal compensatory responses.This publication has 33 references indexed in Scilit:
- The neurohumoral and hemodynamic response to orthostatic tilt in patients with congestive heart failure.Circulation, 1983
- Use of captopril to estimate renin-angiotensin-aldosterone activity in the pathophysiology of chronic heart failureAmerican Heart Journal, 1982
- Mechanisms governing the postural response and baroreceptor abnormalities in chronic congestive heart failure: effects of acute and long-term converting-enzyme inhibition.Circulation, 1982
- Postural hypotension during tilt with chronic captopril and diuretic therapy of severe congestive heart failureAmerican Heart Journal, 1982
- Prediction of the normal blood volume. Relation of blood volume to body habitus.Circulation, 1977
- Simultaneous single isotope radioenzymatic assay of plasma norepinephrine, epinephrine and dopamineLife Sciences, 1977
- The role of the renin-angiotensin-aldosterone system in cardiovascular homeostasis in normal human subjects.Circulation, 1976
- Pulmonary EdemaCirculation, 1972
- Role of Renin in Acute Postural HomeostasisCirculation, 1970
- A Method for the Detection and Quantification of Impaired Sodium ExcretionCirculation, 1965