Sodium Sensitivity as a Main Determinant of Blood Pressure Changes during Early Withdrawal in Heavy Alcoholics

Background Stimulated sympathetic nervous system, renin‐angiotensin‐aldosterone system, vasopressin, and cortisol are thought to affect blood pressure in early withdrawal of alcoholics. Hyperactivity of sodium‐retaining systems with consequent volume expansion also could interact with sodium sensitivity as previously found in long‐term withdrawing alcoholics. Methods To investigate this hypothesis, blood pressure and sodium balance were measured during the first 8 days of withdrawal in 18 chronic alcoholics on a 150 mM Na diet. Results were related to the Salt Sensitivity Index of blood pressure as measured in the same alcoholics after 1 year of abstinence. Results Early withdrawal study: there was a positive sodium balance (+288.6 ± 45.6 mM; p < 0.0001) and rise in mean arterial pressure (+11.8 ± 2.9 mm Hg; p = 0.001) during early withdrawal on 150 mM Na diet. Salt Sensitivity Study after long‐term detoxification: the shift from low (55 mM) to high sodium (260 mM) intake produced a larger ( p = 0.04) increase in mean arterial pressure in alcoholics (+9.3 ± 2.0 mm Hg) than in 30 teetotal controls (+5.1 ± 1.1) (Salt Sensitivity Index, 0.047 ± 0.008 vs. 0.023 ± 0.0053; p < 0.05). Changes in mean blood pressure during withdrawal were highly related to sodium sensitivity index ( r = 0.8; p < 0.001). Conclusions Early withdrawing alcoholics exposed to a normal sodium intake experience positive Na balance and increase in blood pressure that is related to sodium sensitivity measured after long‐term detoxification. This suggests that salt sensitivity plays a key role in blood pressure regulation in early withdrawing alcoholics.