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Effects of lifestyle changes and metformin on salt sensitivity and nitric oxide metabolism in obese salt-sensitive Hispanics

Journal of Human Hypertension volume 21, pages 571–578 (2007)Cite this article

Abstract

Salt sensitivity is associated with obesity, and increased cardiovascular morbidity and mortality. We investigated whether treatment of obesity and its associated metabolic abnormalities corrects salt sensitivity and restores impaired nitric oxide (NO) metabolism characteristic of salt sensitivity. Twenty, otherwise, healthy obese salt-sensitive subjects completed a 12-month program of caloric restriction, aerobic exercise and metformin. Two salt sensitivity tests were performed, that is at baseline and end of program. Lifestyle-metformin treatment decreased weight (9.8±0.3 kg), body mass index (3.9±0.2 kg/m2), waist (11.5±0.5 cm), systolic blood pressure (SBP) (8.6±0.4 mm Hg), diastolic blood pressure (DBP) (5.5±0.4 mm Hg), triglyceride (40±5 mg/dl), fasting (8.3±1 μIU/ml) and post-load (20±4 μIU/ml) insulin levels, and salt sensitivity. Going from a high-sodium (∼300 mmol) to a low-sodium diet (∼30 mmol of sodium/day) lowered SBP/DBP by 14.7±1.7/7.4±0.9 mm Hg at baseline and by 8.6±1.9/3.2±1.2 mm Hg after treatment (P<0.001). More importantly, blood pressure (BP) sensitivity to customary levels of dietary salt (∼150 mmol of sodium/day) was abolished by the lifestyle-metformin treatment. Differences in SBP/DBP between usual and low salt averaged 11±1/8±1 mm Hg before treatment, and 3±1/1±0.5 mm Hg after treatment (P<0.001). At baseline, NO-metabolite excretion was inhibited during high salt; this impairment was corrected by the lifestyle-metformin treatment. In conclusion, acquired correctable factors play an important role in the pathogenesis of salt sensitivity associated with obesity. Correction of salt sensitivity may account for the BP lowering induced by weight reduction. Restoration of the inability to increase or sustain NO production in response to high salt could account for the correction of salt sensitivity induced by the lifestyle-metformin treatment.

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Authors and Affiliations

  1. School of Pharmacy, Clinical Pharmacology Unit, Center for the Detection and Treatment of Silent Risk Factors for Cardiovascular and Metabolic Diseases, Central University of Venezuela, Caracas, Venezula

    I S Hoffmann, A B Alfieri & L X Cubeddu

  2. Department of Pharmaceutical Sciences, Health Professions Division, College of Pharmacy, NOVA Southeastern University (NSU), Fort Lauderdale, FL, USA

    L X Cubeddu

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  1. I S Hoffmann
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  2. A B Alfieri
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  3. L X Cubeddu
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Correspondence to L X Cubeddu.

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Hoffmann, I., Alfieri, A. & Cubeddu, L. Effects of lifestyle changes and metformin on salt sensitivity and nitric oxide metabolism in obese salt-sensitive Hispanics. J Hum Hypertens 21, 571–578 (2007). https://doi.org/10.1038/sj.jhh.1002182

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