Rosaria Del Giorno,1,2,* Christos Ceresa,1,* Sofia Gabutti,1 Chiara Troiani,1 Luca Gabutti1,2
1Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; 2Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
*These authors contributed equally to this work
Correspondence: Rosaria Del Giorno; Luca Gabutti
Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona 6500, Switzerland; Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland Tel +41 91 811 94 08
; +41 91 811 84 64
Email [email protected] [email protected]
Background: Excessive salt intake is an important determinant of cardiovascular (CV) health, impacting arterial stiffness and central blood pressure. However, sodium exhibits several patterns of excretion in urine during day- and night-time, which could differently affect CV risk. Here, we sought to explore the relationship between the day:night urinary sodium excretion ratio and arterial stiffness and central hemodynamics in the general population.
Methods: Cross-sectional analysis in 1062 subjects. Arterial stiffness (pulse-wave velocity, PWV), central blood pressure (central systolic blood pressure, cSBP; central diastolic blood pressure, cDBP), and other hemodynamic parameters were noninvasively assessed. Day- and night-time urinary sodium were separately detected. Analyses were performed according to the day:night urinary sodium excretion ratio tertiles (T1–T3).
Results: Low day-time excretors (T1) showed significantly higher values of arterial stiffness when compared with high day-time excretors (T3) (cf-PWV 7.6 ± 1.9 vs 6.9 ± 1.5 m/sec; p ≤ 0.001), and higher central BP parameters (cSBP: 111.6 ± 12.1 vs 109.0 ± 11.1 mmHg, p ≤ 0.001; cDBP, 76.9 ± 9.2 vs 75.1 ± 9.3 mmHg, p ≤ 0.001). In multivariate linear-regression models (β, CI), the day:night ratio of sodium excretion was significantly associated with arterial stiffness (cf-PWV – 0.386, – 0.559, – 0.213, p ≤ 0.001) and with central hemodynamic parameters (cSBP – 1.655, – 2.800, – 0.510; p ≤ 0.001; cDBP – 1.319, – 2.218, – 0.420, p ≤ 0.001). Associations persisted after controlling for multiple confounding factors. In logistic-regression models, the risk of increased arterial stiffness was significantly reduced as the day:night ratio of urinary sodium excretion increased (OR 0.40, 95% CI 0.25– 0.65, p ≤ 0.001).
Conclusion: The individual, intra-daily pattern of urinary sodium excretion, characterised by low daytime excretion, is associated with increased arterial stiffness and central blood pressure. Further studies are advocated to clarify the clinical utility of assessing the daily pattern of sodium excretion.
Keywords: night-time urinary-sodium excretion, day-time urinary-sodium excretion, arterial stiffness, pulse-wave velocity, central hemodynamics, central blood pressure
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