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Effect of Salt Supplementation on Sympathetic Activity and Endothelial Function in Salt-Sensitive Type 2 Diabetes
Ist Teil von
The journal of clinical endocrinology and metabolism, 2020-04, Vol.105 (4), p.e1187-e1200
Ort / Verlag
US: Oxford University Press
Erscheinungsjahr
2020
Link zum Volltext
Quelle
Oxford Journals 2020 Medicine
Beschreibungen/Notizen
Abstract
Context
Lower sodium intake is paradoxically associated with higher mortality in type 2 diabetes (T2D).
Objective
To determine whether sympathetic nervous system (SNS) activation and endothelial dysfunction contribute to these observations, we examined the effect of salt supplementation on these systems in people with T2D with habitual low sodium. We hypothesized that salt supplementation would lower SNS activity and improve endothelial function compared to placebo.
Design
We conducted a randomized, double-blinded, placebo-controlled crossover trial.
Setting
The study took place in a tertiary referral diabetes outpatient clinic.
Participants
Twenty-two people with T2D with habitual low sodium intake (24-hour urine sodium <150 mmol/24h) were included.
Intervention
Salt supplementation (100 mmol NaCl/24h) or placebo for 3 weeks was administered.
Main outcome measures
The primary outcome of SNS activity and endothelial function was assessed as follows: Microneurography assessed muscle sympathetic nerve activity (MSNA), pulse amplitude tonometry assessed endothelial function via reactive hyperemic index (RHI), and arterial stiffness was assessed via augmentation index (AI). Secondary outcomes included cardiac baroreflex, serum aldosterone, ambulatory blood pressure monitoring (ABPM), heart rate variability (HRV), and salt sensitivity.
Results
Compared to placebo, salt supplementation increased MSNA (burst frequency P = .047, burst incidence P = .016); however, RHI (P = .24), AI (P = .201), ABPM (systolic P = .09, diastolic P = .14), and HRV were unaffected. Salt supplementation improved baroreflex (slope P = .026) and lowered aldosterone (P = .004), and in salt-resistant individuals there was a trend toward improved RHI (P = .07).
Conclusions
In people with T2D and low habitual sodium intake, salt supplementation increased SNS activity without altering endothelial function or blood pressure but improved baroreflex function, a predictor of cardiac mortality. Salt-resistant individuals trended toward improved endothelial function with salt supplementation.