Tuck M, Corry D, Trujillo A
UCLA School of Medicine.
Am J Med. 1990 Mar;88(3):210-6. doi: 10.1016/0002-9343(90)90144-3.
This study evaluates the effects of dietary salt restriction and loading on blood pressure in normotensive and hypertensive patients with non-insulin-dependent diabetes mellitus (NIDDM). Salt sensitivity of blood pressure responses is compared to vascular reactivity to infused angiotensin II on the two sodium diets.
We studied 19 patients with NIDDM (seven normotensive, 12 hypertensive) and seven nondiabetic control subjects under metabolic balance after 6 days on a constant low- (20 mEq) sodium diet and again after 6 days on a high- (250 mEq) sodium diet. Salt sensitivity of blood pressure was determined by the increment in integrated 24-hour blood pressure values on changing from the low- to the high-sodium diet. Blood pressure and plasma aldosterone responses to a graded-dose infusion of angiotensin II were also examined on both sodium diets.
Eight of 12 hypertensive patients with NIDDM displayed salt-sensitive blood pressure responses, whereas none of the normotensive patients with NIDDM or control subjects were salt-sensitive. Patients with NIDDM also had augmented blood pressure responses to infused angiotensin II on both sodium diets when compared to control subjects. Whereas controls had reduced vascular responses to angiotensin II on the low-sodium diet, these responses were not decreased in patients with NIDDM. Patients with NIDDM also retained more sodium on the high-sodium diet than did the control subjects.
Hypertension in patients with NIDDM is frequently salt-sensitive, which may be due to sodium retention and enhanced vascular reactivity to angiotensin II. Since sodium restriction does not normally reduce vascular reactivity to angiotensin II in NIDDM, salt-restricted diets may be less effective in blood pressure control in hypertensive NIDDM.
本研究评估饮食限盐和高盐摄入对非胰岛素依赖型糖尿病（NIDDM）的正常血压和高血压患者血压的影响。将两种钠饮食条件下血压反应的盐敏感性与输注血管紧张素II后的血管反应性进行比较。
我们研究了19例NIDDM患者（7例血压正常，12例高血压）和7例非糖尿病对照者，在代谢平衡状态下，先进行6天恒定的低钠（20 mEq）饮食，然后再进行6天高钠（250 mEq）饮食。血压的盐敏感性通过从低钠饮食改为高钠饮食时24小时血压积分值的增加来确定。在两种钠饮食条件下，还检测了血压和血浆醛固酮对血管紧张素II分级剂量输注的反应。
12例NIDDM高血压患者中有8例表现出盐敏感性血压反应，而NIDDM正常血压患者或对照者均无盐敏感性。与对照者相比，NIDDM患者在两种钠饮食条件下对输注血管紧张素II的血压反应也增强。对照者在低钠饮食时对血管紧张素II的血管反应降低，而NIDDM患者的这些反应并未降低。NIDDM患者在高钠饮食时比对照者保留更多的钠。
NIDDM患者的高血压通常对盐敏感，这可能是由于钠潴留和对血管紧张素II的血管反应性增强所致。由于在NIDDM中限盐通常不会降低对血管紧张素II的血管反应性，限盐饮食在控制NIDDM高血压患者的血压方面可能效果较差。
