Conference Paper

Major Water and Electrolyte Compartment Shifts in Patients with Newly Diagnosed Essential Hypertension: Complementary Use of Two Advanced Bio-Impedance Analysers

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Objective: The natural history of essential hypertension entails a sequence of neuro-endocrine alterations in the human body, which possibly result in body composition and compartment changes that can be detected using bio-impedance analyzers (BIA). Indeed, hypertension may be caused by chronically increased activity of the stress axis and/or renin-angiotensin system via pleiotropic mechanisms, including increased vasoconstriction and salt and water retention. Methods: This was a pilot, two-Center, case-control, cross-sectional study, whose main aim was to evaluate body composition and compartment changes in patients with newly diagnosed untreated essential hypertension using advanced bioimpedometry (BIA-ACC and TomEEx devices, Biotekna Co, Venice, Italy). Psychometric questionnaires (DASS21 and PSS-14 questionnaires) were also administered. Twenty untreated patients [20] with essential hypertension and twenty [20] normotensive age-, gender- and weight- matched controls agreed to participate after meeting the inclusion criteria of the study. Results: The psychometric scores were in the normal range in our hypertensive patients [MdnDASS21DEPRESSION = 8.40, MdnDASS21ANXIETY = 6.36, MdnDASS21STRESS = 12, MdnPSS14= 33], while their fat mass (Hypertensive group: Mdn = 38, Control group: Mdn = 42.75, U = 117, p = 0.024, r = 0.35) and lean body mass (Hypertensive group: Mdn = 62.00, Control group: Mdn = 57.25, U = 117, p = 0.025, r = - 0.35) were, respectively, lesser and greater than those of the controls. Using, impedometry, hypertensive patients demonstrated major body composition and compartment changes compared to controls. They had intracellular dehydration [IntraCellular Water – ICW (%Weight) - (Hypertensive group: Mdn = 53, Control group: Mdn = 56.86, U = 90, p = 0.0020, r = 0.46)], with increased extracellular water volumes [ExtraCellular Water – ECW (%Weight) - (Hypertensive group: Mdn = 47, Control group: Mdn = 43.14, U = 90, p = 0.0023, r = -0.468)], largely deviating from the control group. They also had major differences in potassium and magnesium homeostasis, with a significant augmentation of extracellular potassium (ECK+) as percent of total body potassium (TBK) (Hypertensive group: Mdn = 2.35, Control group: Mdn = 1.96, U = 72, p = 0.0003, r = - 0.545) and a reduced K+/Mg2+ ratio (Hypertensive group: Mdn = 4.5, Control group: Mdn = 4.63, U = 72, p = 0.0042, r = 0.44). Regional spectroscopy (TomEEx) detected presence of increased water or “inflammation” in the entire abdominal area of the hypertensive group. Conclusions: We speculate that body water compartment shifts from the intracellular to the extracellular space, along with potassium loss and low magnesium may be related to the pathophysiology of hypertension. They may reflect a genetic/epigenetic predisposition to stress and/or renin-angiotensin system hyperactivity and/or action that usually presents with hypertension at mid-age.

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... The RAAS occasionally fails to maintain water homeostasis, resulting in dehydration. Apart from water losses, dehydration may also result from shifts in water compartment redistribution; these water shifts are exaggerated by the actions of cortisol [27,28]. ANP increases glomerular filtration rate and the sodium filtration fraction, reduces cardiac output, and inhibits both renin secretion and the aldosterone response to angiotensin [29]. ...
Recent studies have suggested that body composition is key to health and disease. First, fat tissue is a complex, essential, and highly active metabolic and endocrine organ that responds to afferent signals from traditional hormone systems and the central nervous system but also expresses and secretes factors with important endocrine, metabolic, and immune functions. Second, skeletal muscle mass is an important predictor of health in adult life, while severe mass loss has been associated with the frailty of old age. Studies have shown that skeletal muscle is also an important endocrine organ that secretes factors with autocrine, paracrine, or endocrine actions, which have been associated with inflammatory processes. Third, the bone is also a systemic endocrine regulator playing a pivotal role in health and disease. Finally, proper hydration in humans has been neglected as a health factor, especially in adults. Chronic stress and stress hormone hypersecretion alone or associated with distinct disorders, such as anxiety, depression, obesity, metabolic syndrome, autoimmune disorders, type 2 diabetes mellitus, and polycystic ovary syndrome (PCOS), have been associated with psychological and somatic manifestations, typically, increased fat mass, osteosarcopenia/frailty, cellular dehydration, and chronic systemic inflammation. This review aims to provide new insights into the newly developed concept of stress-related osteosarcopenic obesity and its prevention.
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