Relations between erythrocyte lithium efflux, blood pressure and family histories of hypertension and cardiovascular disease: studies in a factory workforce and hypertension clinic.

Sodium-dependent lithium efflux was measured in erythrocytes from 399 factory workers and 125 patients attending a hypertension clinic. Thirty-two factory workers had unsuspected essential hypertension (diastolic blood pressure phase V greater than 90 mmHg). These subjects had the same average erythrocyte lithium efflux as those with normal blood pressure, whereas lithium efflux was increased on average in the clinic hypertensives. Lithium efflux was greater in those subjects from both groups who had a family history of high blood pressure. Our clinic hypertensives did not have raised lithium efflux when they were matched for family history; the increased lithium efflux in the group as a whole (and in analysis of published reports) was explained by an excess of subjects with a family history of hypertension. Furthermore, when a family history of hypertension was present, lithium efflux was increased on average only in those whose relatives also had a cardiovascular event associated with their high blood pressure. These results, in conjunction with detailed analysis of the distributions of lithium efflux within the groups, suggest that, though not linked to blood pressure itself, an increase in lithium efflux is an inherited marker for those at risk from the cardiovascular complications associated with high blood pressure.