摘要
目的探讨盐摄入量与老年难治性高血压(RH)患者诊室血压及家庭自测血压(HBPM)达标的相关性及可能的机制。方法横断面研究我院老年RH患者100例,观察患者使用降压药物数量,测量诊室血压及HBPM,检查24h尿钠水平。将Dahl盐敏感大鼠20只随机分别予正常盐组及高盐组饲料喂养,每组10只。饮食干预12周后,使用微血管张力测定仪检测肠系膜阻力动脉(MRA)对去甲肾上腺素(NE)及血管紧张素Ⅱ(AngⅡ)的反应性,包括血管收缩能力及收缩维持能力。结果100例RH患者24h尿钠平均水平为(175.24±79.76)mmol。低、低-中、中-高及高尿钠患者(各为25例)使用降压药物种类呈显著增多趋势[(3.52±0.65)种vs(3.68±0.75)种vs(3.80±0.76)种vs(3.96±0.78)种,P=0.031]。多因素logistic回归分析显示,诊室血压与24h尿钠水平和≥4种药物独立相关(P<0.05),清晨及上午HBPM与24h尿钠水平独立相关(P<0.05)。高盐饮食12周后,与正常盐组比较,高盐组收缩压及舒张压明显升高(P<0.01)。2组大鼠MRA对NE和AngⅡ的基本张力比较,无统计学差异(P>0.05)。与正常盐组比较,高盐组大鼠MRA对NE的收缩绝对值、最大收缩斜率明显增加,达峰时间明显缩短,5min内松弛绝对值及松弛相对程度明显降低(P<0.05,P<0.01),对AngⅡ的收缩绝对值明显增加(P<0.05)。而2组大鼠MRA对AngⅡ的达峰时间、最大收缩斜率、5min内松弛绝对值及松弛相对程度无统计学差异(P>0.05)。结论高盐饮食是影响老年RH患者应激状态下血压达标的独立因素,而MRA对升压物质的反应性增加可能是其作用机制。
Objective To study the association of salt intake with office BP measurement(OBPM)and home BP measurement(HBPM)in elderly refractory hypertension(RH)patients and its mechanism.Methods One hundred elderly RH patients were included in this study.The kinds of antihypertensive drugs,OBPM and HBPM were recorded and the 24 h urine sodium level was measured in the patients.Twenty Dahl salt-sensitive rats were randomly divided into normal salt intake group(n=10)and high salt intake group(n=10).The reactivities(contractility and contractile maintenance)of mesenteric resistance artery(MRA)to norepinephrine(NE)and angiotensin(Ang)Ⅱwere detected with a microvascular tension detector when the rats were intervened in diets for 12 weeks.Results The average 24 h urine sodium level was 175.24±79.76 mmol.The kinds of antihypertensive drugs showed a significant tendency to increase in patients with a different urinary sodium excretion volume(3.52±0.65 vs 3.68±0.75 vs 3.80±0.76 vs 3.96±0.78,P=0.031).Multivariate logistic regression analysis showed that the OBPM was ind-ependently related with the 24 h urine sodium level and≥4 kinds of antihypertensive drugs(P<0.05)and the morning HBPM and 10am HBPM were related with the 24 h urine sodium level(P<0.05).The SBP and DBP were significantly higher in high salt intake group than in normal salt intake group after 12 weeks of high salt diets(P<0.01).No significant difference was detected in the basic vascular tone of MRA to NE and AngⅡbetween the two groups(P>0.05).The contraction absolute value and maximal contractile slope of MRA to NE were significantly higher,the peaking time of MRA to NE was significantly shorter,the 5-min relaxation absolute value and relative degree of MRA to NE were significantly lower and the contraction absolute value of MRA to AngⅡwas significantly higher in high salt intake group than in normal salt intake group(P<0.05,P<0.01).No significant difference was detected in peaking time,maximal contraction slope,5 min relaxation absolute value and relativ
作者
王青海
李师承
张珈豪
武燕翔
王晨雨
严晓伟
Wang Qinghai;Li Shicheng;Zhang Jiahao;Wu Yanxiang;Wang Chenyu;Yan Xiaowei(Department of Cardiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2019年第9期953-958,共6页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
关键词
氯化钠
膳食
高血压
血压测定
去甲肾上腺素
血管紧张素Ⅱ
sodium chloride,dietary
hypertension
blood pressure determination
norepinephrine
angiotensinⅡ
