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Individuals with hypertension have lower plasma volume regardless of weight status

Abstract

Increased plasma volume is often reported as a cause or symptom of hypertension in individuals with obesity. However, these individuals are often compared to normal weight normotensive individuals. Since higher plasma volumes have been reported in larger individuals, it is possible that plasma volume is actually lower in obese hypertensive individuals compared to normotensive obese individuals. This may be important for better understanding the clinical manifestation of hypertension between weight categories. National Health and Nutritional Examination Survey (cycles 1999–2018) data were used to examine the relationship between plasma (derived from the Straus formula), blood pressure (measured with an automated device) and body mass index. We observed an inverse relationship between estimated plasma volume and systolic (B = −1.68 (95% CI: −2.06, −1.30) mmHg), p < 0.0001), diastolic (B = −3.35 (95% CI: −3.61, −3.08) mmHg) p < 0.0001), and mean arterial pressure (B = −2.79 (95% CI: −3.05, −2.53) mmHg) p < 0.0001). The relationship between estimated plasma volume and diastolic blood pressure (interaction term: B = −0.069 (−0.10, −0.03), p < 0.0001) did depend on BMI. The “normal weight” group had the lowest slope and this slope was significantly different from the “obese” (B = −1.47 (95% CI: −1.88, −1.07)) and “overweight” (B = −1.11 (−1.55, −0.67)) groups. Plasma volume is lower in hypertensive individuals regardless of weight status, but this relationship is more pronounced among obese individuals.

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Fig. 1: The relationship between estimated plasma volume (dL/g) and diastolic blood pressure (mmHg) separated by body mass index (BMI).
Fig. 2: The relationship between estimated plasma volume (dL/g) and mean arterial pressure (mmHg) separated by body mass index (BMI).

Data availability

The data used for this analysis can be found on the NHANES website https://www.cdc.gov/nchs/nhanes/index.htm.

References

  1. Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray CJ, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6:e1000058.

    Article  Google Scholar 

  2. Tarazi RC, Dustan HP, Frohlich ED, Gifford RW Jr., Hoffman GC. Plasma volume and chronic hypertension. Relationship to arterial pressure levels in different hypertensive diseases. Arch Intern Med. 1970;125:835–42.

    CAS  Article  Google Scholar 

  3. Tarazi RC, Frohlich ED, Dustan HP. Plasma volume in men with essential hypertension. N Engl J Med. 1968;278:762–5.

    CAS  Article  Google Scholar 

  4. Chau NP, Safar ME, Weiss YA, London GM, Simon AC, Milliez PL. Relationships between cardiac output, heart rate and blood volume in essential hypertension. Clin Sci Mol Med. 1978;54:175–80.

    CAS  PubMed  Google Scholar 

  5. Blaustein MP, Zhang J, Chen L, Hamilton BP. How does salt retention raise blood pressure? Am J Physiol Regul Integr Comp Physiol. 2006;290:R514–23.

    CAS  Article  Google Scholar 

  6. Hall JE. Guyton and hall textbook of medical physiology. 14. ed. Philadelphia: Elsevier; 2020. pages cm p.

  7. Julius S. Changing role of the autonomic nervous system in human hypertension. J Hypertens Suppl. 1990;8:S59–65.

    CAS  PubMed  Google Scholar 

  8. Hall JE, Mizelle HL, Hildebrandt DA, Brands MW. Abnormal pressure natriuresis. A cause or a consequence of hypertension? Hypertension. 1990;15:547–59.

    CAS  Article  Google Scholar 

  9. Messerli FH, Christie B, DeCarvalho JG, Aristimuno GG, Suarez DH, Dreslinski GR, et al. Obesity and essential hypertension. Hemodynamics, intravascular volume, sodium excretion, and plasma renin activity. Arch Intern Med. 1981;141:81–5.

    CAS  Article  Google Scholar 

  10. Diaz ME. Hypertension and obesity. J Hum Hypertens. 2002;16:S18–22.

    Article  Google Scholar 

  11. Messerli FH, Ventura HO, Reisin E, Dreslinski GR, Dunn FG, MacPhee AA, et al. Borderline hypertension and obesity: two prehypertensive states with elevated cardiac output. Circulation. 1982;66:55–60.

    CAS  Article  Google Scholar 

  12. Ulrych M, Frohlich ED, Tarazi RC, Dustan HP, Page IH. Cardiac output and distribution of blood volume in central and peripheral circulations in hypertensive and normotensive man. Br heart J. 1969;31:570.

    CAS  Article  Google Scholar 

  13. Frohlich ED, Tarazi RC, Dustan HP. Re-examination of the hemodynamics of hypertension. Am J Med Sci. 1969;257:9–23.

    CAS  Article  Google Scholar 

  14. Whelton PK, Carey RM, Aronow WS, Casey DE Jr., Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13–e115.

    CAS  PubMed  Google Scholar 

  15. Atkinson G, Batterham AM. True and false interindividual differences in the physiological response to an intervention. Exp Physiol. 2015;100:577–88.

    Article  Google Scholar 

  16. Johnson CL, Paulose-Ram R, Ogden CL, Carroll MD, Kruszon-Moran D, Dohrmann SM, et al. National health and nutrition examination survey: analytic guidelines, 1999-2010. Vital- Health Stat. 2013;2:1–24.

    Google Scholar 

  17. Duarte K, Monnez JM, Albuisson E, Pitt B, Zannad F, Rossignol P. Prognostic value of estimated plasma volume in heart failure. JACC Heart Fail. 2015;3:886–93.

    Article  Google Scholar 

  18. Ostchega Y, Hughes JP, Terry A, Fakhouri TH, Miller I. Abdominal obesity, body mass index, and hypertension in US adults: NHANES 2007-2010. Am J Hypertens. 2012;25:1271–8.

    PubMed  Google Scholar 

  19. Schmieder RE, Messerli FH, Garavaglia GE, Nunez BD. Dietary salt intake. A determinant of cardiac involvement in essential hypertension. Circulation. 1988;78:951–6.

    CAS  Article  Google Scholar 

  20. Zhang Z, Cogswell ME, Gillespie C, Fang J, Loustalot F, Dai S, et al. Association between usual sodium and potassium intake and blood pressure and hypertension among U.S. adults: NHANES 2005-2010. PLoS One. 2013;8:e75289.

    CAS  Article  Google Scholar 

  21. Gibson JG, Evans WA. Clinical studies of the blood volume. Ii. The relation of plasma and total blood volume to venous pressure, blood velocity rate, physical measurements, age and sex in ninety normal humans. J Clin Invest. 1937;16:317–28.

    CAS  Article  Google Scholar 

  22. Franklin SS, Gustin WT, Wong ND, Larson MG, Weber MA, Kannel WB, et al. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation. 1997;96:308–15.

    CAS  Article  Google Scholar 

  23. Oparil S, Wright JT Jr. Ethnicity and blood pressure. J Clin Hypertens. 2005;7:357–64.

    Article  Google Scholar 

  24. Chrysant SG, Danisa K, Kem DC, Dillard BL, Smith WJ, Frohlich ED. Racial differences in pressure, volume and renin interrelationships in essential hypertension. Hypertension. 1979;1:136–41.

    CAS  Article  Google Scholar 

  25. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.

    Article  Google Scholar 

  26. Julius S, Pascual AV, Reilly K, London R. Abnormalities of plasma volume in borderline hypertension. Arch Intern Med. 1971;127:116–9.

    CAS  Article  Google Scholar 

  27. Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G. Mechanisms of obesity-induced hypertension. Hypertens Res. 2010;33:386–93.

    Article  Google Scholar 

  28. Tanaka M. Improving obesity and blood pressure. Hypertens Res. 2020;43:79–89.

    Article  Google Scholar 

  29. Messerli FH, De Carvalho JG, Christie B, Frohlich ED. Systemic and regional hemodynamics in low, normal and high cardiac output borderline hypertension. Circulation. 1978;58:441–8.

    CAS  Article  Google Scholar 

  30. Granger JP, Alexander BT, Llinas M. Mechanisms of pressure natriuresis. Curr Hypertens Rep. 2002;4:152–9.

    Article  Google Scholar 

  31. Mujais SK, Tarazi RC, Dustan HP, Fouad FM, Bravo EL. Hypertension in obese patients: hemodynamic and volume studies. Hypertension. 1982;4:84–92.

    CAS  Article  Google Scholar 

  32. Shibao C, Gamboa A, Diedrich A, Ertl AC, Chen KY, Byrne DW, et al. Autonomic contribution to blood pressure and metabolism in obesity. Hypertension. 2007;49:27–33.

    CAS  Article  Google Scholar 

  33. Marawan A, Qayyum R. Estimated plasma volume and mortality: analysis from NHANES 1999-2014. Clin Res Cardiol. 2020;109:1148–54.

    Article  Google Scholar 

  34. Fudim M, Miller WL. Calculated estimates of plasma volume in patients with chronic heart failure-comparison with measured volumes. J Card Fail. 2018;24:553–60.

    Article  Google Scholar 

  35. Kobayashi M, Huttin O, Donal E, Duarte K, Hubert A, Le Breton H, et al. Association of estimated plasma volume status with hemodynamic and echocardiographic parameters. Clin Res Cardiol. 2020;109:1060–9.

    CAS  Article  Google Scholar 

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RWS, PDL, and JPL conceived of the idea. PDL performed the statistical analysis. RWS wrote the paper. RWS, PDL, and JPL edited and approved the final manuscript.

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Correspondence to Jeremy P. Loenneke.

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Spitz, R.W., Loprinzi, P.D. & Loenneke, J.P. Individuals with hypertension have lower plasma volume regardless of weight status. J Hum Hypertens (2022). https://doi.org/10.1038/s41371-022-00705-w

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