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Biomedical subjects

A Distler

Publications and source records attributed to A Distler.

At least 55 records · Page 3Linked to original sources

Longitudinal investigation of bacterium-specific synovial lymphocyte proliferation in reactive arthritis and lyme arthritis.

BACKGROUND: Antigen-specific lymphocyte proliferation of synovial fluid mononuclear cells (SF MNC) has been reported repeatedly in reactive arthritis and Lyme arthritis; however, less information is available on serial investigations of SF MNC in the same patients. METHODS: In this study, the synovial lymphocyte proliferation to Yersinia, Chlamydia, Shigella and Borrelia burgdorferi was investigated sequentially at different time points in 28 patients with reactive arthritis, undifferentiated oligoarthritis or Lyme arthritis responding to one of these bacteria. RESULTS: The same bacterium was always recognized in arthritis triggered by Chlamydia, Shigella or Borrelia, with much variation in the proliferative response. Only the Yersinia-specific responses changed specificity, suggesting that the proliferative response to Yersinia is non-specific in some patients. CONCLUSIONS: Our data support the concept of a local antigen-specific T-cell response in reactive arthritis or Lyme arthritis but not the concept suggested by others that a switch to an autoimmune response takes place in long-standing disease.

Antigens, Bacterial↗

Mechanosensitive Ca2+ oscillations and STOC activation in endothelial cells.

Activation of ion channels and the increase in intracellular Ca2+ concentration [Ca2+]i play a key role in endothelial responses to hemodynamic forces and subsequent vasoregulation. In bovine aortic endothelial cells subjected to shear stress in a parallel flow chamber, we demonstrate shear stress activation of hyperpolarizing K+ currents that occur simultaneously with oscillating increases of [Ca2+]i. Oscillating K+ currents, also known as spontaneous transient outward currents (STOC), were regulated in frequency and amplitude by the rate of shear stress in a range from 5 to 18 dyn/cm2. Activation of STOC depended on Ca2+ influx; current depended on the extracellular Ca2+ concentration and was blocked by 50 microM Gd3+. Emptying of Ca2+ stores by BHQ abolished current responses to shear stress. STOC activation was significantly reduced by cell dialysis with ryanodine (20 microM), but not heparin (200 microg/ml). Shear stress-induced STOC activation was also observed in the intact endothelium. The endothelial response to shear stress involves oscillating [Ca2+]i increase and STOC activation, which depend on Ca2+ influx-induced Ca2+ release from ryanodine-sensitive stores, demonstrating a new signaling pathway in endothelial mechanotransduction.

Animals↗

Stretch-activated cation channel in human umbilical vein endothelium in normal pregnancy and in preeclampsia.

OBJECTIVE: To determine whether stretch-activated cation channels (SAC) are present in intact human umbilical vein endothelium (HUVE) and in an endothelial cell line (EA.hy) and whether they act as endothelial mechanosensors, and to determine whether endothelial SAC in HUVE from women with pregnancies complicated by preeclampsia undergo functional changes compared with those in HUVE from women with normotensive pregnancies. METHODS AND RESULTS: By use of the patch-clamp technique we identified a SAC in intact HUVE and in an endothelial cell line. The SAC had mean conductances of 29+/-5 pS (n = 38) for K+ and 12+/-2 pS (n = 4) for Ca2+. Administration of 50 micromol/I gadolinium, a blocker of mechanosensitive ion channels, completely blocked activity of this channel. We found from single-channel recordings that influx of Ca2+ through SAC directly activated high-conductance Ca2+-dependent potassium channels, proving that a significant influx of Ca2+ through SAC occurs at physiologic concentrations of Ca2+. In a comparative study, apparent channel density of SAC (percentage of patches with SAC activity) in HUVE from women with pregnancies complicated by preeclampsia (36.2 +/- 4.3%) was twofold higher than that in HUVE from women with normal pregnancies (17.9+/-2.9%, P< 0.01). Channel conductance and sensitivity to stretching of SAC were not altered by preeclampsia. CONCLUSIONS: Since SAC are capable of acting as endothelial mechanosensors, the greater than normal density of SAC associated with preeclampsia might reflect an alteration of mechanotransduction.

Adult↗

Relationship between angiotensinogen, leptin and blood pressure levels in young normotensive men.

BACKGROUND AND AIMS: Although the relationship between an increase in adipose tissue and a rise in blood pressure has long been recognized, the mechanism linking these two phenomena has yet to be fully understood. Recently, it has become evident that adipose tissue is a rich source of metabolically active molecules, including free fatty acids, leptin and angiotensinogen, the precursor of angiotensin II. The latter finding has prompted speculation on the possible role of adipocyte-derived angiotensinogen in the relationship between body weight and blood pressure. Therefore we examined the relationship between blood pressure, angiotensinogen, body mass index (BMI) and leptin levels in healthy normotensive subjects who are genetically predisposed to the development of hypertension. SUBJECTS AND METHODS: We studied 40 subjects with a positive family history of hypertension and 51 subjects with a negative family history. After the blood pressure measurements, blood samples were collected for the assessment of angiotensinogen, leptin, glucose, insulin, renin activity and electrolytes. Oral glucose tolerance was studied by an oral glucose tolerance test (75 g glucose). RESULTS: Plasma angiotensinogen was significantly correlated with both BMI (r=0.29, P < 0.01) and plasma leptin (r=0.40, P < 0.001). While plasma angiotensinogen and blood pressure were positively correlated only in subjects with a positive family history of hypertension (r=0.33, P< 0.05), plasma leptin was related to blood pressure in both groups (r=0.26, P=0.01). Furthermore, the insulin response to an oral glucose load was significantly related to both plasma angiotensinogen (r=0.22, P< 0.05) and plasma leptin (r=0.47, P< 0.001). CONCLUSIONS: These findings support the hypothesis that circulating angiotensinogen levels are related to adipose mass in young, normotensive, nonobese men. Further studies on the relationship between adipose tissue and systemic or local renin-angiotensin systems appear warranted.

Adipose Tissue↗

Transcriptional regulation of endothelin-1 by erythropoietin in endothelial cells.

Recombinant human erythropoietin (rHuEpo) has been widely used in patients undergoing chronic hemodialysis treatment to correct anemia. In a subgroup of patients, i.v. administration of rHuEpo leads to manifestation or worsening of hypertension. The underlying mechanism of this remains unclear but it has been suggested that it is associated with increased expression of the vasoconstrictor endothelin (ET) in endothelial cells (ECs). There is also evidence for expression of specific rHuEpo receptors on ECs. The aim of this work was to study the time course and mechanisms of ET-1 regulation on the mRNA level in bovine aortic endothelial cells (BAECs) and human umbilical vein endothelial cells (HUVECs) stimulated with pharmacologic doses of rHuEpo (1-10 IU/ml). Compared to vehicle-treated controls, rHuEpo-treatment of ECs increases preproET-1 mRNA expression up to 170%, as shown by Northern blotting. To study the transcriptional regulation of ET-1 expression by rHuEpo, ECs were transfected with a luciferase construct driven by the rat ET-1 promoter and subsequently stimulated with rHuEpo. Compared to controls, luciferase activity increased up to 200% (n = 6; p < 0.05), suggesting transcriptional regulation of preproET-1 mRNA-expression by rHuEpo. Our data support the hypothesis that ET contributes to the hypertensive side effects of rHuEpo treatment and that this interaction occurs at the transcriptional level.

Animals↗

Nitric oxide in sepsis-syndrome: potential treatment of septic shock by nitric oxide synthase antagonists.

Nitric oxide (NO) is an effector molecule with multiple effects on various organ systems. The most prominent physiological actions of NO as a biological mediator include cGMP-dependent vasodilation and cytotoxicity against pathogens in the unspecific immune defense. Sepsis syndrome is a complex disease entity mostly caused by overwhelming bacterial infections. It has a high mortality rate of 40 to 60%. Catecholamine-resistant hypotension and myocardial depression are regarded as major factors contributing to death in septic patients. In septic shock, a pathophysiologically increased NO production occurs due to an excessive induction of the inducible NO synthase (iNOS). Inducible nitric oxide synthase up-regulation is probably caused by bacterial endo- and exotoxins as well as by an increase of circulating pro-inflammatory cytokines. It may be a key factor leading to pronounced vasodilation and myocardial toxicity. Experimental studies have confirmed that NO overproduction causes severe hypotension in septic animals. Treatment with competitive NOS-inhibitors abolishes this hypotension in animals as well as in septic patients. However, their use is complicated by concomitant decreases in cardiac index and oxygen delivery. Conclusive data on mortality in animals and patients with sepsis-syndrome treated by NOS antagonists are not available. This article discusses current concepts concerning the L-arginine/NO system in the pathophysiology of and as a potential therapeutic target in septic shock.

Animals↗

Increased frequency of Sjögren's syndrome in patients with spondyloarthropathy.

OBJECTIVE: To determine the prevalence of sicca symptoms and Sjögren's syndrome (SS) in spondyloarthropathy (SpA) patients with ankylosing spondylitis (AS) and undifferentiated SpA (uSpA). METHODS: Patients with SpA with inflammatory back pain and/or peripheral arthritis presenting to the university outpatient clinic were diagnosed as AS (n = 40) and uSpA (n = 65) according to established criteria. Patients with SpA with sicca symptoms and/or positive antinuclear antibody (ANA) were investigated for SS by minor salivary gland biopsy and/or sialography. To assess sicca symptoms in this cohort systematically we mailed a validated questionnaire with 6 questions on dryness of eyes and mouth to all 105 SpA patients and 150 healthy controls, a positive answer to > or = 3 questions was taken as suggestive of SS. There was no significant difference in baseline characteristics between patients and controls. RESULTS: In 8/105 SpA patients (5 uSpA, 3 AS; 6 female, 2 male) SS diagnosis by the European criteria indicated a frequency of 7.6%. Of 105 SpA patients, 12 were ANA+ (11.4%), of whom 7 had SS; thus, ANA were detected in 7/8 SpA patients with SS (88%). Of the 84 SpA patients responding to the questionnaire (80%), 10 gave a positive answer to > or = 3 questions (11.9%) compared to 2 of 131 (1.5%) controls (87.3%) (odds ratio = 8.7, 95% CI 2.3-32.5, p < 0.01). CONCLUSION: The data suggest increased prevalence of sicca symptoms and SS in SpA patients with AS and uSpA. The occurrence of a secondary SS in a variety of inflammatory diseases suggests that salivary gland involvement in these conditions results from as yet unidentified shared pathogenic mechanisms resulting in nonspecific inflammation in this location.

Adult↗

Randomised, double blind, multicentre comparison of hydrochlorothiazide, atenolol, nitrendipine, and enalapril in antihypertensive treatment: results of the HANE study. HANE Trial Research Group.

OBJECTIVE: To compare the effectiveness and tolerability of hydrochlorothiazide, atenolol, nitrendipine, and enalapril in patients with mild to moderate hypertension. DESIGN: Randomised multicentre trial over 48 weeks with double blind comparison of treatments. SETTING: 48 centres in four countries. PATIENTS: 868 patients with essential hypertension (diastolic blood pressure 95-120 mm Hg) INTERVENTIONS: Initial treatment (step 1) consisted of 12.5 mg hydrochlorothiazide (n = 215), 25 mg atenolol (n = 215), 10 mg nitrendipine (n = 218), or 5 mg enalapril (n = 220) once daily. If diastolic blood pressure was not reduced to < 90 mm Hg within four weeks, doses were increased to 25 mg, 50 mg, 20 mg, 10 mg, respectively, once daily (step 2) and after two more weeks to twice daily (step 3). The eight week titration phase was followed by an additional 40 weeks for patients who had reached the target diastolic pressure. MAIN OUTCOME MEASURES: Blood pressure by means of an automatic device with repeated measurements. RESULTS: After eight weeks the response rate for atenolol (63.7%) was significantly higher than for enalapril (50.0%), hydrochlorothiazide (44.7%), or nitrendipine (44.5%). After one year atenolol was still more effective (48.0%) than hydrochlorothiazide (35.4%) and nitrendipine (32.9%), but not significantly better than enalapril (42.7%). The treatment related dropout rate was higher (P < 0.001) in the nitrendipine group (n = 28). CONCLUSIONS: There is no evidence of superiority for antihypertensive effectiveness or tolerability of the "new" classes of antihypertensives (calcium channel blockers and angiotensin converting enzyme inhibitors). As these drugs are now widely used as treatment of first choice, our results further emphasise the need for studies confirming that they also reduce morbidity and mortality, as has been shown for diuretics and beta blockers.

Adult↗

[Screening and diagnosis for eliminating renovascular hypertension. Value of 24-hour blood pressure monitoring and color-coded duplex ultrasound diagnosis].

BACKGROUND: Direct renal angiography is still the method of choice for identification of renal artery stenosis. Newer non-invasive diagnostic methods include color coded duplex sonography and also ambulatory 24-h blood pressure monitoring, since in a large proportion of patients with secondary forms of hypertension the usual blood pressure fall during nighttime disappears. PATIENTS AND METHODS: In a prospective in-hospital study we investigated 86 patients with suspected renovascular hypertension. Circadian blood pressure was measured oscillometrically and color coded duplex sonography was performed immediately before direct renal angiography. RESULTS: Angiography revealed renal artery stenosis (> or = 50%) in 42 patients. This compared to a sensitivity of 92.9% and specificity of 91.7% for the use of sonography in those patients (70.4%) who could be adequately examined. Mean 24-h pressure values as well as standard deviations of blood pressure means as an indicator for blood pressure variability were not different in the 2 groups of patients, when all the data were analysed together and also when the data for nighttime and daytime were examined separately. The percent of blood pressure fall during nighttime was also not different in the 2 groups. In both groups 4 hypertensive patients had a blood pressure increase during nighttime. In 11 patients without renal artery stenosis a blood pressure fall of < 10% was observed, compared to 12 patients with renal artery stenosis. The circadian pattern of pulse rate was similar in both groups. CONCLUSION: We conclude that ambulatory blood pressure monitoring has a considerably lower diagnostic value for renal artery stenosis compared to angiography and also to color duplex sonography. This method therefore does not appear to be an appropriate screening approach for this kind of secondary hypertension. The color coded duplex sonography, however, seems to be the best non-invasive diagnostic method in those patients, who can be adequately examined.

Adolescent↗

[Costosternal swelling and diffuse bone pain in tubercular osteomyelitis].

HISTORY AND CLINICAL FINDINGS: For about a year a 28-year-old Nigerian had been suffering from diffuse bone pain, intermittent fever, weight loss and weakness. Physical examination was unremarkable except for a swelling at the sternal angle. INVESTIGATIONS: The tuberculin test was clearly positive and tests for inflammatory disease were elevated, but the chest radiograph was normal. Bone scintigraphy demonstrated multiple sites of increased storage in the ribs and vertebral column. Magnetic resonance imaging revealed a large paravertebral abscess, which was needled under computed tomography monitoring. Polymerase chain reaction of the aspirate demonstrated Mycobacterium tuberculosis. TREATMENT AND COURSE: While initial treatment with combined isoniazid, streptomycin, rifampicin and pyrazinamide, the first two drugs had to be discontinued, the microorganism not being sensitive to them, and were replaced by ethambutol and amikacin. The abscess was drained and the vertebral fracture surgically stabilised. There were no neurological abnormalities and the lesions largely healed. CONCLUSION: Even without pulmonary involvement tuberculosis must be included in the differential diagnosis of rheumatic diseases with joint and vertebral column involvement, such as the SAPHO syndrome and other inflammatory bone diseases.

Abscess↗

T cell adhesion to P-selectin induces tyrosine phosphorylation of pp125 focal adhesion kinase and other substrates.

Lymphocyte binding to endothelial surface adhesion molecules is an important early step in inflammation, which is mediated initially by P-selectin and E-selectin. We tested the hypothesis that lymphocyte binding to the selectin adhesion molecules induces intracellular signaling by tyrosine phosphorylation. We used an adhesion assay, which relied on cell binding to chimeric proteins consisting of the extracellular domains for P-selectin and E-selectin. Tyrosine phosphorylation was determined using anti-phosphotyrosine Abs by confocal microscopy and Western blot. Binding to P-selectin induced a significant increase in anti-phosphotyrosine immunoreactivity. The P-selectin effect was time dependent with an early response after 10 min and a maximum effect at 30 min. Western blot showed a time-dependent phosphorylation of two distinct 68- and 125-kDa proteins. These proteins were pp125 focal adhesion kinase (FAK) and paxillin, as shown by immunoprecipitation and colocalization. Phosphorylation of pp125 FAK was time dependent reaching a maximum after 30 min. Incubation with the tyrosine kinase inhibitor genistein, and, to a lesser extent, with the protein kinase C inhibitor staurosporine, resulted in decreased pp125 FAK phosphorylation. Our results are the first to demonstrate that lymphocyte binding to P-selectin induces tyrosine phosphorylation of distinct proteins. Thus, lymphocyte activation may occur already at the initial contact with surface adhesion molecules.

Animals↗

Genetic variants of the renin-angiotensin system, diabetic nephropathy and hypertension.

Recent studies have suggested an association between a deletion (D) variant of the angiotensin-converting-enzyme (ACE) gene and diabetic nephropathy. However, this finding has not been confirmed by all investigators. Furthermore, an M235T variant of the angiotensinogen (AGT) gene has been associated with hypertension, an important risk factor for the development and progression of diabetic nephropathy. The objective of our study was therefore to examine the relationship between these genetic variants of the renin-angiotensin system and diabetic nephropathy and hypertension, respectively, in a large (n = 661) group of Caucasian patients with insulin-dependent (n = 360) or non-insulin-dependent (n = 301) diabetes mellitus. The study had a power of 0.8 to detect a doubling of risk of nephropathy or hypertension in patients with the ACE-DD or AGT-235TT genotype, respectively. Allelic frequencies of the ACE-D and AGT-235T alleles were similar between patients with and without nephropathy in either type of diabetes, and accordingly, there was no significant association between diabetic nephropathy and the ACE or AGT genotype. Likewise, there was no significant association between the ACE or AGT genotype and hypertension. Thus, our data, in this large and ethnically homogeneous group of patients, do not support the hypothesis that these genetic variants of the renin-angiotensin system are strongly associated with either nephropathy or hypertension in patients with insulin-dependent or non-insulin-dependent diabetes mellitus. These genetic markers are therefore unlikely to serve as clinically useful predictors of either nephropathy or hypertension in Caucasian patients with diabetes.

Adult↗

[Autoantibodies against centrosomes in a patient with limited systemic sclerosis with ulcera cruris and arteriopathy--case report and review of the literature].

A 63 year old woman developed painful, up to 15 x 7 cm large ulcers on both lower limbs and an acral necrosis on the right big toe. The patient had no symptoms of intermittent claudication, but a history of 40 package years of cigarette smoking. Angiography showed circumscript stenosis of medium-sized vessels, deformed vessel segments, and rarification and obstruction of peripheral vessels. Arterial occlusive disease was diagnosed, and percutaneous transluminal angioplasty (PTA) of the right common iliac artery and both femoral arteries performed. However, despite documented patency of these vessels clinical symptoms worsened. The consulting rheumatologist found a history of Raynaud's syndrome, acral necrosis of the fourth finger of the right hand, sclerodactylia, and microstomia. Capillaroscopy revealed megacapillaries and vessel rarification. High titers of antinuclear antibodies with specificity for centrosomes (1:10240), which have not been described in this context to date, were detected and limited systemic sclerosis of the CREST type was diagnosed. Treatment with iloprost (50 micrograms/day i.v.) and pulsed cyclophosphamide (800 mg i.v./month) resulted in almost complete healing of the crural and digital ulcers and a significant reduction of the analgetic medication.

Antibodies, Antinuclear↗

IgA nephropathy in a patient with Behçet's syndrome--case report and review of literature.

A 25-yr-old Turkish patient who presented with oral and genital ulcers, erythema nodosum and peripheral arthritis was diagnosed as having Behçet's syndrome (BS). The patient had normal renal function, but persistent proteinuria with 3 g protein loss/day. Renal biopsy revealed glomerulonephritis (GN) with IgA deposits in the membrane. Co-occurrence of BS and IgA nephropathy (IgAN) has only been reported once to date. In contrast to the statements in most current textbooks on BS, the review of the literature presented here suggests that renal involvement is not infrequent, but serious kidney disease is a rather rare event in Behçet's disease.

Adult↗

Genetic variants of the renin-angiotensin system and ambulatory blood pressure in essential hypertension.

OBJECTIVE: To examine whether the angiotensinogen M235T and angiotensin converting enzyme insertion/deletion (I/D) variants are related to the severity of hypertension in patients with established essential hypertension. DESIGN: A cross-sectional study. SETTING: The hypertension clinic of the Benjamin Franklin University Hospital, Free University of Berlin. PARTICIPANTS: Three hundred and forty-three consecutive Caucasian patients who presented with treated or untreated (n = 115) hypertension were enrolled into the study. Twenty-two patients were excluded from analysis because they had secondary hypertension. MAIN OUTCOME MEASURES: Angiotensinogen M235T and angiotensin-converting enzyme I/D genotypes, 24 h ambulatory blood pressure values, the number of antihypertensive medications administered and left ventricular dimensions assessed by two-dimensional echocardiography. RESULTS: Neither the angiotensinogen nor the angiotensin converting enzyme genotype was related significantly to the average ambulatory blood pressure and left ventricular dimensions in hypertensives. Furthermore, neither the number of antihypertensive medications administered to treated patients nor blood pressure levels in untreated patients (n = 115) differed significantly between the genotypic groups. CONCLUSIONS: These results do not support the hypothesis that the studied molecular variants of the renin-angiotensin system may represent clinically useful markers of the severity of hypertension in Caucasians with established essential hypertension.

Adult↗

Hpa II polymorphism of the atrial natriuretic peptide gene and the blood pressure response to salt intake in normotensive men.

OBJECTIVE: To test the hypothesis that the Hpa II variant of the atrial natriuretic peptide gene (ANP), which has been reported to be more common among black hypertensives than it is among normotensive controls, is related to the response of blood pressure to salt intake in normotensive Caucasians. METHODS: One hundred and three young (aged 19-35 years) male volunteers were fed a low-salt diet (20 mmol NaCl/day) for 2 weeks and a supplement of either 200 mmol NaCl/day (slow sodium) or placebo for 1 week each in a randomized double-blind cross-over order. Salt sensitivity was defined as a significant (P < 0.05) decrease in resting mean arterial blood pressure by > 3 mmHg under the low-salt diet. The genotype was determined by amplification of genomic DNA extracted from peripheral leukocytes and subsequent digestion of the amplicon with Hpa II restriction enzyme. RESULTS: According to the above definition, 27 subjects were salt sensitive. There were no significant differences in age, body-mass index and waist:hip ratio between the salt-sensitive and salt-resistant groups. Only salt-sensitive subjects displayed a significantly higher blood pressure under the high-salt diet (increase in mean arterial pressure 5.6 +/- 2.4 mmHg, P < 0.001). The prevalence of the ANP-Hpa II wild-type (w) allele did not differ between the salt-sensitive (qw = 1.0, qm = 0) and the salt-resistant group (qw = 0.96, qm = 0.04). Furthermore, the salt-induced response of blood pressure did not differ between homozygotes (ww) and heterozygotes (wm). CONCLUSIONS: Our findings do not support the hypothesis that the ANP-Hpa II polymorphism is a marker for salt sensitivity in young Caucasian normotensives.

Adult↗

Relationship between ambulatory and resting blood pressure responses to dietary salt restriction in normotensive men.

OBJECTIVE: To examine the relationship between changes in resting and ambulatory blood pressures induced by dietary salt restriction in 90 young normotensive men. METHODS: Subjects were given a standardized low-salt diet containing 20 mmol sodium chloride per day for 14 days. To this diet, a daily supplement of 20 tablets of slow sodium (10 mmol NaCl per tablet) or placebo was added in a randomized single-blind cross-over fashion for 7 days. The ambulatory blood pressure was measured on the sixth day and the resting blood pressure was measured on the seventh day of each dietary period. RESULTS: Although salt intake did not affect blood pressure levels in the whole group, the response of the blood pressure was quite variable among individual subjects. Salt-induced changes in resting systolic (r = 0.30, P = 0.006) and mean (r = 0.27, P = 0.014) blood pressures, but not diastolic blood pressure, were correlated positively to changes in daytime ambulatory blood pressure. The changes in resting systolic and mean blood pressures were also correlated significantly to the nocturnal falls in systolic (r = 0.26, P = 0.015) and mean (r = 0.27, P = 0.012) blood pressure levels and heart rate (r = 0.26, P= 0.015) under the high-salt diet. Diet-induced changes in resting mean blood pressure were correlated significantly to the daytime ambulatory blood pressure (r = 0.30, P < 0.005) and the resting heart rate (r = 0.24, P < 0.02) under the high-salt diet. CONCLUSION: Salt-induced changes in resting blood pressure in young normotensive men are correlated positively to changes in ambulatory daytime blood pressure levels as well as to the daytime ambulatory blood pressure and the nocturnal fall in blood pressure under a high-salt diet. These findings suggest that dietary salt-intake restriction can lower both resting and daytime ambulatory blood pressure levels in some normotensive individuals who may be predisposed to the development of hypertension.

Adult↗