盐负荷对老年高血压患者靶器官功能的影响_West China Medical Journal

Authors：

 梁瑞 ,  张新军

四川大学华西医院老年病科（成都 610041）;

Corresponding author：

张新军, Email: alexzhang34@163.com

Keywords：

盐负荷状态; 老年高血压; 靶器官功能; 盐敏感性

DOI：

10.7507/1002-0179.20150449

Video：

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盐负荷状态是影响个体血压水平的重要环境因素，长期高盐饮食增加人群高血压的患病率。高盐负荷对靶器官功能的损害可独立于血压而存在，并且在盐敏感人群中损害更明显。老年高血压人群中盐敏感者所占比例较大，适度限盐在一定程度上会降低心脑血管疾病的死亡率，是老年高血压非药物治疗的重要环节。

Citation： 梁瑞, 张新军. 盐负荷对老年高血压患者靶器官功能的影响. West China Medical Journal, 2015, 30(8): 1562-1566. doi: 10.7507/1002-0179.20150449 Copy

1.	Denton D, Weisinger R, Mundy NI, et al. The effect of increased salt intake on blood pressure of chimpanzees[J]. Nat Med, 1995, 1(10):1009-1016.
2.	Intersalt Cooperative Research Goup. INTERSALT:an international study of electrolyte excretion and blood pressure[J]. BMJ, 1988, 297(6644):319-328.
3.	Polónia J, Maldonado J, Ramos R, et al. Estimation of salt intake by urinary sodium excretion in a Portuguese adult population and its relationship to arterial stiffness[J]. Rev Port Cardiol,2006, 25(9):801-817.
4.	王陇德. 全国居民营养与健康状况调查2002综合报告[M]. 北京:人民卫生出版社, 2002:53-57.
5.	WHO. WHO document production services:geneva, switzerland; Guideline:sodium intake for adults and children[M/OL]. Geneva:World Health Organization, 2012. http://apps.who.int/iris/bitstream/10665/77985/1/9789241504836_eng.pdf.
6.	Dyer A, Elliott P, Chee D, et al. Urinary biochemical markers of dietary intake in the INTERSALT study[J]. Am J Clin Nutr, 1997, 65(4 Suppl):1246S-1253S.
7.	Stamler J, Elliott P, Dennis B, et al. INTERMAP:background, aims, design, methods, and descriptive statistics (nondietary)[J]. J Hum Hypertens, 2003, 17(9):591-608.
8.	Weinberger MH, Fineberg NS, Fineberg SE, et al. Salt sensitivity, pulse pressure, and death in normal and hypertensive humans[J]. Hypertension, 2001, 37(2 Pt 2):429-432.
9.	李晓玫, 王海燕, 张鸣和. 老年肾脏及钠代谢改变[J]. 临床内科杂志, 1990, 7(6):13-14.
10.	Harris PJ, Hiranyachattada S, Antoine AM, et al. Regulation of renal tubular Sodium transport by angiotension Ⅱ and atrial natriuretic factor[J]. Clin Exp Pharmacol Physiol, 1996, 23(Supple 3):112-118.
11.	Campese VM, Karubian F, Chervu I, et al. Pressor reactivity to norepinephrine and angiotensin in salt-sensitive hypertensive patients[J]. Hypertension, 1993, 21(3):301-307.
12.	Safar ME, Thuilliez C, Richard V, et al. Pressure-independent contribution of sodium to large artery structure and function in hypertension[J]. Cardiovasc Res, 2000, 46(2):269-276.
13.	Yu HC, Burrell LM, Black MJ, et al. Salt induces myocardial and renal fibrosis in normotensive and hypertensive rats[J]. Circulation, 1998, 98(23):2621-2628.
14.	Ying WZ, Sanders PW. Dietary salt increases endothelial nitric oxide synthase and TGF-beta 1 in rat aortic endothelium[J]. Am J Physiol, 1999, 277(4 Pt 2):H1293-H1298.
15.	陈瑗, 周玫. 氧化应激-炎症在动脉粥样硬化发生发展中作用研究的新进展[J]. 中国动脉硬化杂志, 2008, 16(10):757-762.
16.	Avolio A. Salt sensitivity and arterial structure and function[J]. J Hypertens, 2003, 21(2):251-253.
17.	Draaijer P, Kool MJ, Maessen JM, et al. Vascular distensibility and compliance in salt-sensitive and salt-resistant borderline hypertension[J]. J Hypertens, 1993, 11(11):1199-1207.
18.	Avolio AP, Deng FQ, Li WQ, et al. Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension:comparison between urban and rural communities in china[J]. Circulation, 1985, 71(2):202-210.
19.	张海锋, 李新立, 周艳丽, 等. 尿钠排泄量与动脉弹性指数的关系[J]. 中华高血压杂志, 2010, 18(4):353-356.
20.	Benetos A, Xiao YY, Cuche JL, et al. Arterial effects of salt restriction in hypertensive patients. A 9-week, randomized, double-blind, crossover study[J]. J Hypertens, 1992, 10(4):355-360.
21.	Du Cailar G, Mimran A. Non-pressure-related effects of dietary sodium[J]. Curr Hypertens Rep, 2007, 9(2):154-159.
22.	Schiffrin EL. Vascular endothelin in hypertension[J]. Vascul Pharmacol, 2005, 43(1):19-29.
23.	Higashi Y, Oshima T, Watanabe M, et al. Renal response to L-arginine in salt-sensitive patients with essential hypertension[J]. Hypertension, 1996, 27(3 Pt 2):643-648.
24.	Chen PY, Sanders PW. Role of nitric oxide synthesis in salt-sensitive hypertension in Dahl/Rapp rats[J]. Hypertension, 1993, 22(6):812-818.
25.	周继红, 朱佩芳, 王正国, 等. 高渗盐液对离体灌流左心室舒缩功能的影响[J]. 创伤外科杂志, 2000, 2(1):38-41.
26.	Desimone G, Devereux RB, Camargo MJ, et al. Reduction of development of left ventricular hypertrophy in salt-loaded Dahl salt-sensitive rats by angiotensin Ⅱ receptor inhibition[J]. Am J Hypertens, 1996, 9(3):216-222.
27.	Du Cailar G, Ribstein J, Daures JP, et al. Sodium and left ventricular mass in untreated hypertensive and normotensive subjects[J]. Am J Physiol, 1992, 263(1 Pt 2):H177-H181.
28.	Feron O, Salomone S, Godfraind T. Influence of salt loading on the cardiac and renal preproendothelin-1 mRNA expression in stroke-prone spontaneously hypertensive rats[J]. Biochem Biophys Res Commun, 1995, 209(1):161-166.
29.	Schmieder RE, Langenfeld MR, Friedrich A, et al. Angiotensin Ⅱ related to Sodium excretion modulates left ventricular structure in human essential hypertension[J]. Circulation, 1996, 94(6):1304-1309.
30.	Ott C, Titze SI, Schwarz TK, et al. High sodium intake modulates left ventricular mass in patients with G expression of +1675 G/A angiotensin Ⅱ receptor type 2 gene[J]. J Hypertens, 2007, 25(8):1627-1632.
31.	李长育, 于晓明, 张振刚, 等. 盐负荷对高血压病患者血压及肾脏钠、钾排泄功能的影响[J]. 中华心血管病杂志, 1994, 22(2): 87-89, 154.
32.	Tripathi S, Tripathi K. Role of kidney in hypertension[J]. J Indian Med Assoc, 2003, 101(4):260-262.
33.	Bigazzi R, Bianchi S, Baldari D, et al. Microalbuminuria in salt-sensitive patients. A marker for renal and cardiovascular risk factors[J]. Hypertension, 1994, 23(2):195-199.
34.	Beard TC, Cooke HM, Gray WR, et al. Randomised controlled trial of a no-added-sodium diet for mild hypertension[J]. Lancet, 1982, 2(8296):455-458.
35.	Altun B, Arici M. Salt and blood pressure:time to challenge[J]. Cardiology, 2006, 105(1):9-16.
36.	Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality:a meta-analysis of individual data for one million adults in 61 prospective studies[J]. Lancet, 2002, 360(9349):1903-1913.
37.	刘治全, 侯嵘, 刘杰, 等. 盐敏感者在人群中的分布及血压正常盐敏感者的特点[J]. 高血压杂志, 1998, 6(1):32-35.
38.	Hooper L, Bartlett C, Davey Smith G, et al. Systematic review of long term effects of advice to reduce dietary salt in adults[J]. BMJ, 2002, 325(7365):628.
39.	牟建军, 刘治全. 限盐对血压及心血管健康的作用受到挑战了吗?[J]. 中华高血压杂志, 2011, 19(11):1001-1004.
40.	Tuomilehto J, Jousilahti P, Rastenyte D, et al. Urinary sodium excretion and cardiovascular mortality in Finland:a prospective study[J]. Lancet, 2001, 357(9259):848-851.
41.	Cook NR, Cutler JA, Obarzanek E, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes:observational follow-up of the trials of hypertension prevention (TOHP)[J]. BMJ, 2007, 334(7599):885-888.
42.	Safar M, Laurent S, Safavian A, et al. Sodium and large arteries in hypertension:effects of indapamide[J]. Am J Med, 1988, 84(1B):15-19.
43.	ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic:the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. JAMA, 2002, 288(23):2981-2987.
44.	Jamerson KA, Bakris GL, Wun CC, et al. Rationale and design of the avoiding cardiovascular events through combination therapy in patients living with systolic hypertension (ACCOMPLISH) trial-The first randomized controlled trial to compare the clinical outcome effects of first-line combination therapies in hypertension[J]. Am J Hypertens, 2004, 17(9):793-801.
45.	Patel A, ADVANCE Collaborative Group, Macmahon S, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial):a randomised controlled trial[J]. Lancet, 2007, 370(9590):829-840.
46.	Bulpitt CJ, Fletcher AE, Amery A, et al. The hypertension in the very elderly trial (HYVET)[J]. Drugs Aging, 1994, 5(3):171-183.
47.	Cherchi A, Sau F, Seguro C. Possible regression of left ventricular hypertrophy during antihypertensive treatment with diuretics and/or beta blockers[J]. J Clin Hypertens, 1987, 3(2):216-225.
48.	SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension[J]. JAMA, 1991, 265(24):3255-3264.
49.	Weinberger MH, Miller JZ, Luft FC, et al. Definitions and characteristics of Sodium sensitivity and blood pressure resistance[J]. Hypertension, 1986, 8(6 Pt 2):II127-II134.

1. Denton D, Weisinger R, Mundy NI, et al. The effect of increased salt intake on blood pressure of chimpanzees[J]. Nat Med, 1995, 1(10):1009-1016.
2. Intersalt Cooperative Research Goup. INTERSALT:an international study of electrolyte excretion and blood pressure[J]. BMJ, 1988, 297(6644):319-328.
3. Polónia J, Maldonado J, Ramos R, et al. Estimation of salt intake by urinary sodium excretion in a Portuguese adult population and its relationship to arterial stiffness[J]. Rev Port Cardiol,2006, 25(9):801-817.
4. 王陇德. 全国居民营养与健康状况调查2002综合报告[M]. 北京:人民卫生出版社, 2002:53-57.
5. WHO. WHO document production services:geneva, switzerland; Guideline:sodium intake for adults and children[M/OL]. Geneva:World Health Organization, 2012. http://apps.who.int/iris/bitstream/10665/77985/1/9789241504836_eng.pdf.
6. Dyer A, Elliott P, Chee D, et al. Urinary biochemical markers of dietary intake in the INTERSALT study[J]. Am J Clin Nutr, 1997, 65(4 Suppl):1246S-1253S.
7. Stamler J, Elliott P, Dennis B, et al. INTERMAP:background, aims, design, methods, and descriptive statistics (nondietary)[J]. J Hum Hypertens, 2003, 17(9):591-608.
8. Weinberger MH, Fineberg NS, Fineberg SE, et al. Salt sensitivity, pulse pressure, and death in normal and hypertensive humans[J]. Hypertension, 2001, 37(2 Pt 2):429-432.
9. 李晓玫, 王海燕, 张鸣和. 老年肾脏及钠代谢改变[J]. 临床内科杂志, 1990, 7(6):13-14.
10. Harris PJ, Hiranyachattada S, Antoine AM, et al. Regulation of renal tubular Sodium transport by angiotension Ⅱ and atrial natriuretic factor[J]. Clin Exp Pharmacol Physiol, 1996, 23(Supple 3):112-118.
11. Campese VM, Karubian F, Chervu I, et al. Pressor reactivity to norepinephrine and angiotensin in salt-sensitive hypertensive patients[J]. Hypertension, 1993, 21(3):301-307.
12. Safar ME, Thuilliez C, Richard V, et al. Pressure-independent contribution of sodium to large artery structure and function in hypertension[J]. Cardiovasc Res, 2000, 46(2):269-276.
13. Yu HC, Burrell LM, Black MJ, et al. Salt induces myocardial and renal fibrosis in normotensive and hypertensive rats[J]. Circulation, 1998, 98(23):2621-2628.
14. Ying WZ, Sanders PW. Dietary salt increases endothelial nitric oxide synthase and TGF-beta 1 in rat aortic endothelium[J]. Am J Physiol, 1999, 277(4 Pt 2):H1293-H1298.
15. 陈瑗, 周玫. 氧化应激-炎症在动脉粥样硬化发生发展中作用研究的新进展[J]. 中国动脉硬化杂志, 2008, 16(10):757-762.
16. Avolio A. Salt sensitivity and arterial structure and function[J]. J Hypertens, 2003, 21(2):251-253.
17. Draaijer P, Kool MJ, Maessen JM, et al. Vascular distensibility and compliance in salt-sensitive and salt-resistant borderline hypertension[J]. J Hypertens, 1993, 11(11):1199-1207.
18. Avolio AP, Deng FQ, Li WQ, et al. Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension:comparison between urban and rural communities in china[J]. Circulation, 1985, 71(2):202-210.
19. 张海锋, 李新立, 周艳丽, 等. 尿钠排泄量与动脉弹性指数的关系[J]. 中华高血压杂志, 2010, 18(4):353-356.
20. Benetos A, Xiao YY, Cuche JL, et al. Arterial effects of salt restriction in hypertensive patients. A 9-week, randomized, double-blind, crossover study[J]. J Hypertens, 1992, 10(4):355-360.
21. Du Cailar G, Mimran A. Non-pressure-related effects of dietary sodium[J]. Curr Hypertens Rep, 2007, 9(2):154-159.
22. Schiffrin EL. Vascular endothelin in hypertension[J]. Vascul Pharmacol, 2005, 43(1):19-29.
23. Higashi Y, Oshima T, Watanabe M, et al. Renal response to L-arginine in salt-sensitive patients with essential hypertension[J]. Hypertension, 1996, 27(3 Pt 2):643-648.
24. Chen PY, Sanders PW. Role of nitric oxide synthesis in salt-sensitive hypertension in Dahl/Rapp rats[J]. Hypertension, 1993, 22(6):812-818.
25. 周继红, 朱佩芳, 王正国, 等. 高渗盐液对离体灌流左心室舒缩功能的影响[J]. 创伤外科杂志, 2000, 2(1):38-41.
26. Desimone G, Devereux RB, Camargo MJ, et al. Reduction of development of left ventricular hypertrophy in salt-loaded Dahl salt-sensitive rats by angiotensin Ⅱ receptor inhibition[J]. Am J Hypertens, 1996, 9(3):216-222.
27. Du Cailar G, Ribstein J, Daures JP, et al. Sodium and left ventricular mass in untreated hypertensive and normotensive subjects[J]. Am J Physiol, 1992, 263(1 Pt 2):H177-H181.
28. Feron O, Salomone S, Godfraind T. Influence of salt loading on the cardiac and renal preproendothelin-1 mRNA expression in stroke-prone spontaneously hypertensive rats[J]. Biochem Biophys Res Commun, 1995, 209(1):161-166.
29. Schmieder RE, Langenfeld MR, Friedrich A, et al. Angiotensin Ⅱ related to Sodium excretion modulates left ventricular structure in human essential hypertension[J]. Circulation, 1996, 94(6):1304-1309.
30. Ott C, Titze SI, Schwarz TK, et al. High sodium intake modulates left ventricular mass in patients with G expression of +1675 G/A angiotensin Ⅱ receptor type 2 gene[J]. J Hypertens, 2007, 25(8):1627-1632.
31. 李长育, 于晓明, 张振刚, 等. 盐负荷对高血压病患者血压及肾脏钠、钾排泄功能的影响[J]. 中华心血管病杂志, 1994, 22(2): 87-89, 154.
32. Tripathi S, Tripathi K. Role of kidney in hypertension[J]. J Indian Med Assoc, 2003, 101(4):260-262.
33. Bigazzi R, Bianchi S, Baldari D, et al. Microalbuminuria in salt-sensitive patients. A marker for renal and cardiovascular risk factors[J]. Hypertension, 1994, 23(2):195-199.
34. Beard TC, Cooke HM, Gray WR, et al. Randomised controlled trial of a no-added-sodium diet for mild hypertension[J]. Lancet, 1982, 2(8296):455-458.
35. Altun B, Arici M. Salt and blood pressure:time to challenge[J]. Cardiology, 2006, 105(1):9-16.
36. Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality:a meta-analysis of individual data for one million adults in 61 prospective studies[J]. Lancet, 2002, 360(9349):1903-1913.
37. 刘治全, 侯嵘, 刘杰, 等. 盐敏感者在人群中的分布及血压正常盐敏感者的特点[J]. 高血压杂志, 1998, 6(1):32-35.
38. Hooper L, Bartlett C, Davey Smith G, et al. Systematic review of long term effects of advice to reduce dietary salt in adults[J]. BMJ, 2002, 325(7365):628.
39. 牟建军, 刘治全. 限盐对血压及心血管健康的作用受到挑战了吗?[J]. 中华高血压杂志, 2011, 19(11):1001-1004.
40. Tuomilehto J, Jousilahti P, Rastenyte D, et al. Urinary sodium excretion and cardiovascular mortality in Finland:a prospective study[J]. Lancet, 2001, 357(9259):848-851.
41. Cook NR, Cutler JA, Obarzanek E, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes:observational follow-up of the trials of hypertension prevention (TOHP)[J]. BMJ, 2007, 334(7599):885-888.
42. Safar M, Laurent S, Safavian A, et al. Sodium and large arteries in hypertension:effects of indapamide[J]. Am J Med, 1988, 84(1B):15-19.
43. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic:the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. JAMA, 2002, 288(23):2981-2987.
44. Jamerson KA, Bakris GL, Wun CC, et al. Rationale and design of the avoiding cardiovascular events through combination therapy in patients living with systolic hypertension (ACCOMPLISH) trial-The first randomized controlled trial to compare the clinical outcome effects of first-line combination therapies in hypertension[J]. Am J Hypertens, 2004, 17(9):793-801.
45. Patel A, ADVANCE Collaborative Group, Macmahon S, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial):a randomised controlled trial[J]. Lancet, 2007, 370(9590):829-840.
46. Bulpitt CJ, Fletcher AE, Amery A, et al. The hypertension in the very elderly trial (HYVET)[J]. Drugs Aging, 1994, 5(3):171-183.
47. Cherchi A, Sau F, Seguro C. Possible regression of left ventricular hypertrophy during antihypertensive treatment with diuretics and/or beta blockers[J]. J Clin Hypertens, 1987, 3(2):216-225.
48. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension[J]. JAMA, 1991, 265(24):3255-3264.
49. Weinberger MH, Miller JZ, Luft FC, et al. Definitions and characteristics of Sodium sensitivity and blood pressure resistance[J]. Hypertension, 1986, 8(6 Pt 2):II127-II134.

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盐负荷对老年高血压患者靶器官功能的影响

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