Connell J M, Whitworth J A, Davies D L, Richards A M, Fraser R
MRC Blood Pressure Unit, Western Infirmary, Glasgow, UK.
J Hypertens. 1988 Jan;6(1):17-23.
The effect of a dietary sodium restriction (15 mmol/day) on the development of adrenocorticotrophic hormone (ACTH) hypertension was examined in six normal male subjects. When ACTH (1 mg/day) was given for 5 days to subjects on a sodium-restricted diet, systolic blood pressure rose (116 +/- 4 to 125 +/- 4 mmHg, P less than 0.001), while diastolic blood pressure was unchanged. There was a modest antinatriuresis (cumulative Na+ balance, 59 +/- 2 mmol) which was reflected in a small rise in exchangeable body sodium (65 +/- 15 mmol); plasma concentrations of active renin and angiotensin II both fell during ACTH treatment. Plasma volume rose (2.8 +/- 0.2 to 3.6 +/- 0.16 l, P less than 0.01) while extracellular fluid volume was unchanged. Plasma concentration of atrial natriuretic peptide (ANP) rose to more than twice basal. Glomerular filtration rate (inulin clearance) increased (111 +/- 9 to 131 +/- 7 ml/min, P less than 0.001), renal plasma flow, measured as the rate of para-aminohippurate (PAH) clearance, was unaltered and calculated filtration fraction rose. Dietary sodium restriction did not, therefore, prevent an ACTH-induced increase in blood pressure. The increase in plasma volume with ACTH is not dependent on renal sodium retention and is associated with increased concentrations of ANP. When these data are compared with findings previously reported in subjects given the same dose of ACTH when on normal or high sodium intakes, it is clear that, although the action of ACTH in raising blood pressure is not dependent on exogenous sodium or extracellular fluid volume expansion, sodium retention can modify the level of blood pressure attained.
在6名正常男性受试者中研究了饮食中钠限制（15 mmol/天）对促肾上腺皮质激素（ACTH）性高血压发展的影响。当对钠限制饮食的受试者给予ACTH（1 mg/天），持续5天时，收缩压升高（从116±4 mmHg升至125±4 mmHg，P<0.001），而舒张压未改变。存在适度的抗利尿作用（累积Na+平衡为59±2 mmol），这反映在可交换身体钠略有增加（65±15 mmol）；ACTH治疗期间活性肾素和血管紧张素II的血浆浓度均下降。血浆容量增加（从2.8±0.2升增至3.6±0.16升，P<0.01），而细胞外液容量未改变。心房利钠肽（ANP）的血浆浓度升至基础值的两倍以上。肾小球滤过率（菊粉清除率）增加（从111±9 ml/分钟增至131±7 ml/分钟，P<0.001），以对氨基马尿酸（PAH）清除率衡量的肾血浆流量未改变，计算得出的滤过分数增加。因此，饮食中钠限制并不能预防ACTH诱导的血压升高。ACTH导致的血浆容量增加不依赖于肾钠潴留，且与ANP浓度增加有关。当将这些数据与先前报道的正常或高钠摄入时给予相同剂量ACTH的受试者的研究结果进行比较时，很明显，尽管ACTH升高血压的作用不依赖于外源性钠或细胞外液容量扩张，但钠潴留可改变所达到的血压水平。
