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低剂量沙库巴曲缬沙坦对盐敏感性高血压肾病的不同影响。

Differential effects of low-dose sacubitril and/or valsartan on renal disease in salt-sensitive hypertension.

机构信息

Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.

Institute of Cytology, Russian Academy of Sciences, St. Petersburg, Russia.

出版信息

Am J Physiol Renal Physiol. 2020 Jul 1;319(1):F63-F75. doi: 10.1152/ajprenal.00125.2020. Epub 2020 May 28.

Abstract

Diuretics and renin-angiotensin system blockers are often insufficient to control the blood pressure (BP) in salt-sensitive (SS) subjects. Abundant data support the proposal that the level of atrial natriuretic peptide may correlate with the pathogenesis of SS hypertension. We hypothesized here that increasing atrial natriuretic peptide levels with sacubitril, combined with renin-angiotensin system blockage by valsartan, can be beneficial for alleviation of renal damage in a model of SS hypertension, the Dahl SS rat. To induce a BP increase, rats were challenged with a high-salt 4% NaCl diet for 21 days, and chronic administration of vehicle or low-dose sacubitril and/or valsartan (75 μg/day each) was performed. Urine flow, Na excretion, and water consumption were increased on the high-salt diet compared with the starting point (0.4% NaCl) in all groups but remained similar among the groups at the end of the protocol. Upon salt challenge, we observed a mild decrease in systolic BP and urinary neutrophil gelatinase-associated lipocalin levels (indicative of alleviated tubular damage) in the valsartan-treated groups. Sacubitril, as well as sacubitril/valsartan, attenuated the glomerular filtration rate decline induced by salt. Alleviation of protein cast formation and lower renal medullary fibrosis were observed in the sacubitril/valsartan- and valsartan-treated groups, but not when sacubitril alone was administered. Interestingly, proteinuria was mildly mitigated only in rats that received sacubitril/valsartan. Further studies of the effects of sacubitril/valsartan in the setting of SS hypertension, perhaps involving a higher dose of the drug, are warranted to determine if it can interfere with the progression of the disease.

摘要

利尿剂和肾素-血管紧张素系统阻滞剂通常不足以控制盐敏感(SS)受试者的血压(BP)。大量数据支持这样的观点,即心房利钠肽的水平可能与 SS 高血压的发病机制相关。我们在这里假设,通过给予沙库巴曲来增加心房利钠肽的水平,并与缬沙坦联合阻断肾素-血管紧张素系统,可以有益于缓解 SS 高血压模型中即达沙坦 SS 大鼠的肾脏损伤。为了诱导血压升高,大鼠接受高盐 4%NaCl 饮食 21 天,并进行载体或低剂量沙库巴曲和/或缬沙坦(75μg/天)的慢性给药。与起始点(0.4%NaCl)相比,所有组的尿流量、Na 排泄和水消耗在高盐饮食时均增加,但在方案结束时各组之间仍相似。在盐挑战时,我们观察到在缬沙坦治疗组中收缩压和尿中性粒细胞明胶酶相关脂质运载蛋白水平(表明肾小管损伤减轻)轻度下降。沙库巴曲以及沙库巴曲/缬沙坦减轻了盐诱导的肾小球滤过率下降。在沙库巴曲/缬沙坦和缬沙坦治疗组中观察到蛋白铸型形成减轻和肾髓质纤维化程度降低,但单独给予沙库巴曲时则没有观察到这种情况。有趣的是,只有接受沙库巴曲/缬沙坦治疗的大鼠的蛋白尿轻度减轻。在 SS 高血压的背景下进一步研究沙库巴曲/缬沙坦的作用,可能涉及更高剂量的药物,是有必要的,以确定它是否可以干扰疾病的进展。

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