van Bommel E F H
Albert Schweitzer Ziekenhuis, afd. Interne Geneeskunde, Postbus 444, 3300 AK Dordrecht.
Ned Tijdschr Geneeskd. 2003 Feb 8;147(6):240-4.
For many years there has been ongoing controversy concerning the presumed relationship between salt intake and population blood pressure. In addition, in light of the availability of many efficient antihypertensive drugs and the frequent difficulty to motivate patients to maintain prolonged salt restriction, clinicians often doubt the importance of salt restriction in the individual treatment of hypertension. Accumulating data now underline the importance of a restriction of salt intake on a population level. This is expressed in a recent advice of the Dutch Health Council (Gezondheidsraad) and governmental intervention in some other countries. However, it is not the level of salt intake but salt sensitivity of blood pressure which predicts the effect of salt restriction in the individual treatment of essential hypertension. It should be noted that salt restriction or depletion will increase the sensitivity to other antihypertensive drugs in each form of hypertension. Recent data suggest that salt sensitivity per se should be viewed as an independent risk factor for cardiovascular morbidity and mortality. Therefore, identification and aggressive treatment of salt-sensitive hypertension, including salt restriction, is indicated. Demographic and racial characteristics as well as additional laboratory investigation may help identifying potential 'salt-sensitive' subjects, who form part of a high-risk population.
多年来，关于盐摄入量与人群血压之间的假定关系一直存在争议。此外，鉴于有许多有效的降压药物，且常常难以激励患者长期坚持限盐，临床医生常常怀疑限盐在高血压个体治疗中的重要性。目前越来越多的数据强调了在人群层面限制盐摄入量的重要性。这体现在荷兰卫生委员会（健康委员会）最近的一项建议以及其他一些国家的政府干预中。然而，在原发性高血压的个体治疗中，预测限盐效果的并非盐摄入量水平，而是血压的盐敏感性。应当指出的是，限盐或减少盐摄入会增加每种高血压形式对其他降压药物的敏感性。最近的数据表明，盐敏感性本身应被视为心血管发病和死亡的一个独立危险因素。因此，对盐敏感性高血压进行识别并积极治疗，包括限盐，是必要的。人口统计学和种族特征以及其他实验室检查可能有助于识别潜在的“盐敏感”个体，他们构成了高危人群的一部分。
