Obesity modifies the relationship between ambulatory blood pressure and natriuresis in children.

BACKGROUND: The objective in the present study was to evaluate if obesity beginning in the first two decades of life influences the relationship between ambulatory blood pressure and urinary sodium excretion. DESIGN AND METHODS: Eighty-five obese and 88 non-obese children aged 3-19 years were included in the study. For each subject, a 24h ambulatory blood pressure monitoring and a complete urine collection were simultaneously performed according to the protocols designed. The averages of ambulatory blood pressure and of the urinary excretion rates for sodium, potassium and creatinine were calculated separately for 24-h, awake and sleep periods as defined by a mini-diary.
RESULTS: Weight and sodium excretion are directly associated with systolic blood pressure; however, the relationship between blood pressure and sodium excretion seems to be modified in obese children as compared to controls. The interaction between sodium excretion and weight was negative indicating that the rate of change of systolic blood pressure by sodium unit is smaller for the obese than for the non-obese, even though at the same urinary sodium excretion level the obese children had higher ambulatory systolic blood pressure.
CONCLUSIONS: Obesity during the first two decades of life seems to restrict sodium excretion, leading to higher blood pressure values. The capacity to excrete sodium seems to be heterogeneous, the lowest capacity being at the highest blood pressure values. Subsets of the obese, those with the lowest ability to excrete sodium, may be further protected by low sodium intake in order to prevent a rise in blood pressure.