Skin-specific mechanisms of body fluid regulation in hypertension

Increasing evidence suggests excess skin Na(+) accumulation in hypertension; however, the role of skin-specific mechanisms of local Na(+)/water regulation remains unclear. We investigated the association between measures of sweat and trans-epidermal water loss (TEWL) with Na(+) content in the skin ([Na(+)](skin)) and clinical characteristics in consecutive hypertensive patients. We obtained an iontophoretic pilocarpine-induced sweat sample, a skin punch biopsy for chemical analysis, and measures of TEWL from the upper limbs. Serum vascular endothelial growth factor-c (VEGF-c) and a reflectance measure of haemoglobin skin content served as surrogates of skin microvasculature. In our cohort (n = 90; age 21–86 years; females = 49%), sweat composition was independent of sex and BMI. Sweat Na(+) concentration ([Na(+)](sweat)) inversely correlated with [K(+)](sweat) and was higher in patients on ACEIs/ARBs (P < 0.05). A positive association was found between [Na(+)](sweat) and [Na(+)](skin), independent of sex, BMI, estimated Na(+) intake and use of ACEi/ARBs (P(adjusted) = 0.025); both closely correlated with age (P < 0.01). Office DBP, but not SBP, inversely correlated with [Na(+)](sweat) independent of other confounders (P(adjusted) = 0.03). Total sweat volume and Na(+) loss were lower in patients with uncontrolled office BP (P(adjusted) < 0.005 for both); sweat volume also positively correlated with serum VEGF-c and TEWL. Lower TEWL was paralleled by lower skin haemoglobin content, which increased less after vasodilatory pilocarpine stimulation when BMI was higher (P = 0.010). In conclusion, measures of Na(+) and water handling/regulation in the skin were associated with relevant clinical characteristics, systemic Na(+) status and blood pressure values, suggesting a potential role of the skin in body-fluid homeostasis and therapeutic targeting of hypertension.