原发性高血压患者24h尿钠与血浆肾素活性、醛固酮水平及血压节律的关系

The relationship of 24-hour urinary sodium with plasma renin activity,aldosterone concentration and the circadian blood pressure variations in patients with essential hypertension

目的分析原发性高血压患者24h尿钠与血浆肾素活性、醛固酮水平及血压昼夜节律之间的关系。方法回顾性分析2010年1月至2014年12月连续住院的原发性高血压患者1284例。根据24h尿钠排泄量评价患者的盐摄入量,将患者分为3组:低尿钠组(24h尿钠<100 mmol)362例,中等尿钠组(24h尿钠100~200 mmol)675例,高尿钠组(24h尿钠>200mmol)247例。对各组血浆肾素活性、醛固酮水平及24h动态血压情况进行分析。结果本研究人群平均24h尿钠水平为(145±69)mmol,估算平均每日摄盐量为(8.48±4.04)g。经性别、年龄、体质量指数校正后,与低尿钠组相比,中等尿钠组和高尿钠组的血浆肾素活性明显降低[(2.77±0.08)、(2.49±0.14)比(3.34±0.11)μg/(L·h),均P<0.05],高尿钠组的醛固酮水平低于中等尿钠组和低尿钠组[(150.2±5.4)比(161.8±3.2)、(175.2±4.4)ng/L,均P<0.05]。高尿钠组的24h、白天及夜间平均收缩压、舒张压较低尿钠组及中等尿钠组均明显升高(均P<0.01)。高尿钠组非杓型血压比例高于低尿钠组(P<0.05)。非杓型及夜间高血压患者的24h尿钠水平较杓型和非夜间高血压患者高(均P<0.05)。结论高盐摄入患者的血浆肾素活性及醛固酮水平较低,血压水平较高,更多表现为非杓型血压及夜间高血压。

Objective To investigate the relationships of 24-hour urinary sodium （UNa＋ } with plasma rennin activity （PRA）, aldosterone concentration （PAC） and the circadian blood pressure variations in essential hypertensive patients. Methods From January 2010 to December 2014, 1284 essential hypertensive patients were enrolled and divided into low （UNa^＋〈100 mmol, n=362）, moderate （UNa^＋ 100-200 mmol,n=675） and high urinary sodium groups （UNa^＋ 〉200 mmol,n=247）. The relationships of 24 h UNa＋ with PRA, PAC and 24 h ambulatory blood pressure were analyzed in these 3 groups. Results The mean 24 h UNa＋ was （145±69） mmol, corresponding to salt （8.48±4.04） g. After adjusted for covariates, the levels of PRA in moderate and high sodium group were significantly lower compared with low sodium group [-（2.77±0.08）, （2.49±0.14） vs （3.34±0.11） μg/{L · h）], and the levels of PAC in high sodium group were lower than that in moderate and low sodium group [（150.2±5.4） vs （161.8±3.2）, （175.2 ± 4.4） ng/L; all P〈0.05]. The 24 hour mean blood pressure, daytime blood pressure and night-time blood pressure were all significantly higher in high sodium group compared with other two groups. The prevalence of non-dippers was significantly higher in high sodium group than in low sodium group. The value of 24 h UNa＋ were higher in non-dippers and nocturnal hypertension patients than in dippers and non-nocturnal hy- pertension patients. Conclusion In this study, higher salt intake hypertension patients had lower PRA and PAC levels, higher blood pressure levels, and higher prevalence of non-dippers and nocturnal hypertension.