Weder A B, Schork N J, Krause L, Julius S
University of Michigan, Department of Internal Medicine, Ann Arbor 48109.
Hypertension. 1991 May;17(5):652-60. doi: 10.1161/01.hyp.17.5.652.
Human essential hypertension has more than one cause, but to dissect out subtypes, markers are required. The maximal activity of red blood cell lithium-sodium countertransport has been shown to be increased in hypertensive patients in case-control and population-based studies; in the latter, its distribution is a mixture of two overlapping but distinguishable subpopulations. In the present study, we classified 705 participants in the Tecumseh Blood Pressure Study as having either normal (mean, 0.234 mmol/l cells/hr; n = 614) or high (mean, 0.463 mmol/l cells/hr; n = 91) red blood cell lithium-sodium countertransport to determine if the red blood cell marker is associated with distinctive physiological characteristics. We found that subjects with elevated lithium-sodium countertransport have higher average blood pressure and a greater prevalence of hypertension than those with normal countertransport and that elevated blood pressure had been present since youth. Hemodynamically, the high countertransport group is characterized by elevated vascular resistance, whereas sympathetic nervous system activity appears to be slightly depressed. Subjects with increased lithium-sodium countertransport, compared with those with normal countertransport, have significantly lower average left ventricular mass index and only very infrequently demonstrate left ventricular hypertrophy. Our results support the usefulness of measurements of the maximal activity of red blood cell lithium-sodium countertransport as a way of distinguishing subgroups in the population. Our data are consistent with the idea that subjects with an elevated maximal activity for red blood cell lithium-sodium countertransport are a subset of the population with a genetic lesion that predisposes them to the development of essential hypertension.
人类原发性高血压的病因不止一种，但要剖析出亚型，则需要标志物。在病例对照研究和基于人群的研究中均显示，高血压患者红细胞锂 - 钠逆向转运的最大活性增加；在基于人群的研究中，其分布是两个重叠但可区分的亚群的混合。在本研究中，我们将蒂康西血压研究中的705名参与者分类为红细胞锂 - 钠逆向转运正常（平均0.234 mmol/l细胞/小时；n = 614）或偏高（平均0.463 mmol/l细胞/小时；n = 91），以确定该红细胞标志物是否与独特的生理特征相关。我们发现，锂 - 钠逆向转运升高的受试者比逆向转运正常的受试者平均血压更高，高血压患病率也更高，而且高血压自年轻时就已存在。从血流动力学角度来看，高逆向转运组的特点是血管阻力升高，而交感神经系统活动似乎略有降低。与逆向转运正常的受试者相比，锂 - 钠逆向转运增加的受试者平均左心室质量指数显著更低，很少表现出左心室肥厚。我们的结果支持将红细胞锂 - 钠逆向转运最大活性的测量作为区分人群中亚组的一种方法的有效性。我们的数据与以下观点一致，即红细胞锂 - 钠逆向转运最大活性升高的受试者是具有遗传病变的人群亚组，这种遗传病变使他们易患原发性高血压。
