Jones Erika, Rayner Brian
Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
E13 Groote Schuur Hospital, Observatory, Cape Town, 7925, South Africa.
Pediatr Nephrol. 2021 Feb;36(2):237-243. doi: 10.1007/s00467-019-04427-z. Epub 2020 Jan 2.
Hypertension is highly prevalent in Black Africans and has been found to be associated with worse blood pressure (BP) control and more cardiovascular disease. Black Africans are more salt sensitive with low renin and aldosterone levels. This can be explained in part by variants in the epithelial sodium channel (ENaC) causing an increase in channel activity resulting in sodium and water retention. These variants in the ENaC are increased in the Black African populations presumably due to selective pressure for sodium retention in traditionally low-salt diets. Furthermore, increased endothelial sodium channel activity contributes to the risk of vascular stiffness, which may also result in more difficult to control hypertension. Patients with increased activity of the ENaC are more likely to respond to amiloride (a selective sodium channel antagonist), which has implications for the management of severe and resistant hypertension in Black Africans. A large-scale controlled trial on the use of amiloride compared to usual care is warranted in Blacks with severe or resistant hypertension.
高血压在非洲黑人中极为普遍，并且已发现其与较差的血压（BP）控制及更多的心血管疾病相关。非洲黑人对盐更为敏感，肾素和醛固酮水平较低。这部分可以通过上皮钠通道（ENaC）的变异来解释，这些变异导致通道活性增加，从而引起钠和水潴留。ENaC中的这些变异在非洲黑人人群中增加，可能是由于传统低盐饮食中对钠潴留的选择性压力所致。此外，内皮钠通道活性增加会导致血管僵硬风险增加，这也可能导致高血压更难控制。ENaC活性增加的患者更有可能对氨氯吡咪（一种选择性钠通道拮抗剂）产生反应，这对非洲黑人严重和难治性高血压的管理具有重要意义。对于患有严重或难治性高血压的黑人，有必要进行一项关于使用氨氯吡咪与常规治疗相比的大规模对照试验。
