Thread by @nick_krontiris

This one finds that increased aldosterone levels may not necessarily lead to increased blood pressure.

- This is a translational inpatient trial deigned to elucidate the biological pathway leading from nutritional changes, through hormonal response, reversal of urine electrolytes ratio, to blood pressure reduction.

- Volunteers were admitted for 14 days, transitioning from a SAD to a DASH diet.

- Urine electrolyte excretion is governed by the mineralocorticoid hormone aldosterone.

- Aldosterone reacts to two opposing stimuli in what is known as the aldosterone paradox; during hypovolemia, both aldosterone and angiotensin II are secreted to retain sodium with minimal potassium secretion.

In response to potassium loading, aldosterone alone, and not angiotensin II, is secreted, leading to a potassium secreting state.

- In this study, participants’ BMI remained stable throughout the admission period with slight reductions ranging between 0 and 3% in the first three days of intervention.

- Mean daily urine volume, for all participants, decreased from the first collection to the second by 18% on average.

Mean serum aldosterone concentration at screening was 8.3 ± 5.0 ng/dL and increased on day 5 to a mean concentration of 17.8 ± 5.8 ng/dL.

Mean aldosterone was higher on day 5 compared to the other sampling timepoints.

Mean aldosterone level decreased in all participants by day 11, to a mean concentration of 11.5 ± 4.7 ng/dL and returned to baseline at follow up, 8.6 ± 4.7 ng/dL.

- Paradoxically, even though shifting from a high-sodium/low-potassium diet to a high-potassium/low-sodium diet led to an increase in aldosterone increase, this was accompanied with a blood pressure reduction.

This reduction paralleled a decline in the urine sodium/potassium ratio.

Across the entire trial period, the difference in the mean urine sodium/potassium ratio was statistically significant, but when separated into two periods, the difference between means between days 1 and 5 was significant, whereas there was no difference after that.

So that peak in aldosterone 5 days after intervention, paralleled the decline in urine electrolytes ratio.

Serum aldosterone and urine electrolytes dynamics in response to DASH diet intervention – An inpatient mechanistic study (open access)

doi.org/10.1017/cts.20…

#nutrition #diet #Hypertension #BloodPressure