Rhee O J, Rhee M Y, Oh S W, Shin S J, Gu N, Nah D Y, Kim S W, Lee J H
Department of Social Welfare, Soongsil University, Seoul, Republic of Korea.
Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
Int J Cardiol. 2016 Jul 15;215:120-6. doi: 10.1016/j.ijcard.2016.04.109. Epub 2016 Apr 14.
We evaluated the association between sodium intake and plasma renin levels in the cross sectional study and meta-analysis of randomized controlled trials, whether there is a persistent elevation of plasma renin by longer-term sodium intake restriction.
Plasma renin activity (PRA) and 24-h urine sodium (24HUNa) excretion were measured from individuals randomly selected from a community. Simple and multiple linear regression analyses adjusted for age, 24-h systolic blood pressure, 24-h average heart rate, fasting blood glucose and gender were performed. For meta-analysis, 74 studies published from 1975 to mid-2014 were identified in a systematic literature search using EMBASE, CINAHL, and MEDLINE. Random effects meta-analyses and a meta-regression analysis were performed.
Among the 496 participants recruited, 210 normotensive and 87 untreated hypertensive subjects were included in the analysis. There was no significant association between PRA and 24HUNa in the total population, or hypertensive and normotensive individuals. In the meta-analysis, the standard mean difference (SMD) of renin level by sodium intake reduction was 1.26 (95% CI: 1.08 to 1.44, Z=12.80, P<0.001, I(2)=87%). In the meta-regression analysis, an increase in a day of intervention was associated with a fall in SMD by -0.04 (95% CI: -0.05 to -0.02, Z=-5.27, P<0.001, I(2)=86%), indicating that longer duration of reduced sodium intake would lead to lesser SMD of renin level.
The present population based cross-sectional study and meta-analysis suggests that prolonged reduction in sodium intake is very unlikely associated with elevation of plasma renin levels.
在横断面研究以及随机对照试验的荟萃分析中，我们评估了钠摄入量与血浆肾素水平之间的关联，即长期限制钠摄入是否会导致血浆肾素持续升高。
从一个社区随机选取个体，测量其血浆肾素活性（PRA）和24小时尿钠（24HUNa）排泄量。进行了调整年龄、24小时收缩压、24小时平均心率、空腹血糖和性别的单因素和多因素线性回归分析。对于荟萃分析，通过使用EMBASE、CINAHL和MEDLINE进行系统文献检索，确定了1975年至2014年年中发表的74项研究。进行了随机效应荟萃分析和荟萃回归分析。
在招募的496名参与者中，分析纳入了210名血压正常者和87名未经治疗的高血压患者。在总体人群、高血压患者和血压正常者中，PRA与24HUNa之间均无显著关联。在荟萃分析中，钠摄入量减少导致的肾素水平标准平均差（SMD）为1.26（95%CI：1.08至1.44，Z = 12.80，P < 0.001，I² = 87%）。在荟萃回归分析中，干预天数增加与SMD下降-0.04相关（95%CI：-0.05至-0.02，Z = -5.27，P < 0.001，I² = 86%），表明钠摄入量减少的持续时间越长，肾素水平的SMD越小。
目前基于人群的横断面研究和荟萃分析表明，长期减少钠摄入量极不可能与血浆肾素水平升高相关。
