Schmid M, Mann J F, Stein G, Herter M, Nussberger J, Klingbeil A, Ritz E
Department of Internal Medicine, University of Heidelberg, Federal Republic of Germany.
J Hypertens. 1990 Mar;8(3):277-83.
We studied, under outpatient conditions, nine patients with autosomal dominant polycystic kidney disease who were hypertensive on their usual diet, and nine normotensive healthy probands. The subjects were examined in random order on the 7th day after equilibration on a low-sodium diet (20 mmol/day) and again on the 7th day after equilibration on the same diet but with added sodium to yield a final intake of 200 mmol/day (or vice versa). Blood pressure was monitored non-invasively for 2 h at 4-min intervals using an automatic system. In healthy probands, mean arterial pressure (MAP) was similar on the low- and the high-sodium diets (92.7 versus 91.9 mmHg). In hypertensive patients, a significant (P less than 0.02) increase in mean MAP (107.2 versus 111.2 mmHg) and in systolic blood pressure (140.6 versus 148.7 mmHg) was observed irrespective of whether the glomerular filtration rate (GFR) was normal or reduced. The natriuresis pressure curve showed an upward shift (resetting) and a positive slope (sodium sensitivity). Patients with a reduced GFR as shown by inulin clearance differed from probands and patients with a normal GFR, by showing greater proportional changes in GFR and body weight. In hypertensive patients, atrial natriuretic factor (ANF) levels were higher at baseline and showed an exaggerated response to sodium loading. Changes in angiotensin II (Ang II) or in Ang II binding sites on platelets were similar in patients and controls and changed appropriately with the sodium intake. These data show a resetting of the natriuresis-blood pressure relationship and an increased blood pressure sensitivity to sodium in hypertensive patients with adult, dominant, polycystic kidney disease.
我们在门诊条件下研究了9例常染色体显性遗传性多囊肾病患者，他们在日常饮食时患有高血压，以及9例血压正常的健康对照者。受试者在低钠饮食（20 mmol/天）平衡7天后按随机顺序接受检查，然后在同样饮食但添加钠使最终摄入量达到200 mmol/天（或反之）的平衡7天后再次接受检查。使用自动系统以4分钟的间隔对血压进行2小时的无创监测。在健康对照者中，低钠和高钠饮食时的平均动脉压（MAP）相似（92.7对91.9 mmHg）。在高血压患者中，无论肾小球滤过率（GFR）正常或降低，均观察到平均MAP显著升高（P<0.02）（107.2对111.2 mmHg）以及收缩压升高（140.6对148.7 mmHg）。利钠压力曲线显示向上移位（重置）和正斜率（钠敏感性）。菊粉清除率显示GFR降低的患者与对照者以及GFR正常的患者不同，前者GFR和体重的比例变化更大。在高血压患者中，心房利钠因子（ANF）水平在基线时较高，并且对钠负荷表现出过度反应。患者和对照组中血管紧张素II（Ang II）或血小板上Ang II结合位点的变化相似，并且随钠摄入量适当变化。这些数据表明，在患有成人显性多囊肾病的高血压患者中，利钠-血压关系发生了重置，并且血压对钠的敏感性增加。
