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Pediatric Hypertension pp 221–232Cite as

Stress and Salt Sensitivity in Childhood Hypertension

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Abstract

The pressure response to sodium is heterogeneous among both persons with normal blood pressure and with hypertension. Nevertheless, sodium restriction is typically recommended for everyone with hypertension. As reviewed here, categorizing a person as “salt sensitive” has important prognostic and therapeutic implications. Determination of salt sensitivity is typically accomplished by assessment of the pressure response to administration of an oral or intravenous sodium load. In this chapter, we discuss an alternative way to administer a sodium load through stress exposure. Animal and human studies have demonstrated clinically significant sodium retention during and after stress, which in effect generates positive sodium balance and thus delivers a sodium load. Persons demonstrating this response develop a volume-dependent blood pressure elevation. Similar to findings in salt-sensitive populations, target organ changes have also been associated with impaired sodium handling during stress. Sodium retention in response to stress has been reported as improved or reversed after treatment with antihypertensive medications that block the renin-angiotensin-aldosterone system. Evidence suggests that the variability of the pressure response to dietary sodium intake and to stress should be considered in our strategies to prevent and control hypertension.

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Abbreviations

ABPM:

Ambulatory blood pressure monitoring

ACEi:

Angiotensin-converting enzyme inhibitor

ARB:

Angiotensin receptor blocker

BMI:

Body mass index

BP:

Blood pressure

DASH:

Dietary Approaches to Stop Hypertension

GFR:

Glomerular filtration rate

GRK4:

G protein-coupled receptor kinase 4

OR:

Odds ratio

RAAS:

Renin-angiotensin-aldosterone system

SNS:

Sympathetic nervous system

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, Seattle Children’s Hospital, 4800 Sand Point Way NE, MS: OC.9.820, Seattle, WA, 98105, USA

    Coral D. Hanevold

  2. Department of Pediatrics, Augusta University, Annex H.S. 1640, Augusta, GA, 30912-4534, USA

    Gregory A. Harshfield

Authors
  1. Coral D. Hanevold
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  2. Gregory A. Harshfield
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Corresponding author

Correspondence to Coral D. Hanevold .

Editor information

Editors and Affiliations

  1. University of Washington School of Medicine, Department of Pediatrics and Seattle Children’s Hospital Division of Nephrology, Seattle, WA, USA

    Joseph T. Flynn

  2. Division of Nephrology MassGeneral for Children at Massachusetts General Hospital, Harvard Medical School Department of Pediatrics, Boston, MA, USA

    Julie R. Ingelfinger

  3. St. Luke’s Health System, Children’s Nephrology and Hypertension, Boise, ID, USA

    Karen M. Redwine

Section Editor information

  1. Pediatric Nephrology Unit, MassGeneral Hospital for Children at MGH, Harvard Medical School, Fruit St. 55, 02114, Boston, MA, USA

    Julie R. Ingelfinger M.D.

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Hanevold, C.D., Harshfield, G.A. (2018). Stress and Salt Sensitivity in Childhood Hypertension. In: Flynn, J., Ingelfinger, J., Redwine, K. (eds) Pediatric Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-31107-4_18

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  • DOI: https://doi.org/10.1007/978-3-319-31107-4_18

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