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The association of arterial stiffness with estimated excretion levels of urinary sodium and potassium and their ratio in Chinese adults

Journal of Human Hypertension volume 37, pages 292–299 (2023)Cite this article

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Abstract

Arterial stiffness is an independent cardiovascular risk factor. However, the association between sodium/potassium intake and arterial stiffness in the Chinese population is unclear. Therefore, we performed a large, community-based cross-sectional study to reach a more definitive conclusion. The study was conducted at the Third Xiangya Hospital in Changsha between August 2017 and September 2019. Urinary sodium, potassium, and creatinine levels were tested from spot urine samples during physical examinations of each recruited participant. The 24-hour estimated urinary sodium excretion (eUNaE) and estimated urinary potassium excretion (eUKE) levels were calculated using the Kawasaki formula (used as a surrogate for intake). The brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI) were measured using an automatic waveform analyzer. In 22,557 subjects with an average age of 49.3 ± 10.3 years, the relationships of the ABI and baPWV with the levels of eUNaE, eUKE and the ratio of sodium to potassium (Na/K ratio) were analyzed. A significant negative relationship was found between the eUKE and baPWV levels (β = 2.41, p < 0.01), whereas the Na/K ratio was positively associated with baPWV (β = 2.46, p < 0.01), especially in the overweight and hypertensive populations (both pinteraction = 0.04). The association of eUNaE quartiles with baPWV presented a J-shaped curve after adjusting for confounders. In addition, a positive association was observed between the Na/K ratio and the ABI (β = 0.002, p < 0.01). In this study, high potassium and/or low sodium intake was further confirmed to be related to vascular stiffness in Chinese individuals.

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Fig. 1: Flow chart of participant selection.
Fig. 2: The association of baPWV and ABI with eUNaE, eUKE levels and the Na/K ratio in quartile subgroups.
Fig. 3: Forest plots of changes in the baPWV and ABI per unit increase in the Na/K ratio.

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Data availability

The dataset and code supporting the conclusions of this article are available upon reasonable request from the authors.

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Acknowledgements

We gratefully acknowledge the voluntary participation of all the study subjects. This work was supported by funding from the National Science Foundation of China (81973324, 81872685, and 82003537), the Hunan Young Talent grant (2020RC3063), the Hunan Science Foundation (2020JJ5858, 2020JJ4439) and the Wisdom Accumulation and Talent Cultivation Project of the Third XiangYa Hospital of Central South University (YX202002).

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  1. These authors contributed equally: Qinyu Yang, Weihong Jiang.

Authors and Affiliations

  1. Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China

    Qinyu Yang, Pingting Yang & Ying Li

  2. Department of Pharmacology, Xiangya School of Pharmaceutical Science, Central South University, Changsha, Hunan, China

    Qinyu Yang, Congke Zhao, Lijun Li & Xiaohui Li

  3. Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China

    Weihong Jiang

  4. Department of Health Management, Aerospace Center Hospital, Beijing, China

    Yongmei He

  5. Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada

    Lin Yang

  6. Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Lin Yang

  7. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China

    Lu Yin

  8. Hunan Key Laboratory for Bioanalysis of Complex Matrix Samples, Changsha, Hunan, China

    Xiaohui Li & Ying Li

  9. Department of Epidemiology, Hunan Normal University School of Medicine, Changsha, China

    Xin Huang

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Contributions

QY, WH, Lu Yin, YM, and Xin Huang produced data for analysis. QY, WH, Lin Yang and YL wrote the manuscript. YL designed the study. CK, LJ, PT, and Xiao Hui included patients for the study. All authors reviewed and edited the manuscript. YL and Xin Huang handled funding and supervision. All authors read and approved the final manuscript.

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Correspondence to Ying Li.

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Yang, Q., Jiang, W., He, Y. et al. The association of arterial stiffness with estimated excretion levels of urinary sodium and potassium and their ratio in Chinese adults. J Hum Hypertens 37, 292–299 (2023). https://doi.org/10.1038/s41371-022-00671-3

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