Safar M, Laurent S, Safavian A, Pannier B, Asmar R
Diagnosis Center, Broussais Hospital, Paris, France.
Am J Med. 1988 Jan 29;84(1B):15-9.
Epidemiologic studies evaluating arterial pulse wave velocity together with blood pressure indicate that: (1) salt intake has an independent effect on arteriolar tone and arterial wall properties, with the former indirectly and the latter directly contributing to increased arterial stiffness with age; and (2) normotensive adult subjects who follow a low sodium diet have reduced arterial stiffness and this effect is independent of blood pressure. Conversely, in elderly persons with isolated systolic hypertension, isotonic saline infusion causes a predominant increase in systolic pressure due to an increase in the stiffness of the arterial wall. The diuretic indapamide produces a decrease in blood pressure without significant change in brachial artery diameter. The result indicates a shift of the pressure-diameter curve, reflecting for the first time in humans a pharmacologic effect of the drug on arterial vessel. Furthermore, diuretic drugs may increase arterial distensibility and compliance in hypertensive patients, but this effect seems to be more pronounced in older than in younger subjects. In the latter, either activation of the sympathetic nervous system or potassium depletion, or both, might counteract the improvement in arterial distensibility caused by blood pressure reduction and sodium depletion. Based on epidemiologic, clinical, and pharmacologic studies, this critical review suggests that, in patients with essential hypertension, changes of sodium intake in diet or administration of diuretics, or both, affect the status of large arteries independently of blood pressure changes.
（1）盐摄入对小动脉张力和动脉壁特性具有独立影响，随着年龄增长，前者间接、后者直接导致动脉僵硬度增加；（2）遵循低钠饮食的血压正常成年受试者动脉僵硬度降低，且这种影响独立于血压。相反，在单纯收缩期高血压的老年人中，静脉输注等渗盐水会因动脉壁僵硬度增加而导致收缩压显著升高。利尿剂吲达帕胺可降低血压，而肱动脉直径无明显变化。结果表明压力 - 直径曲线发生偏移，这首次在人体中反映出该药物对动脉血管的药理作用。此外，利尿剂可能会增加高血压患者的动脉扩张性和顺应性，但这种作用在老年患者中似乎比年轻患者更明显。在年轻患者中，交感神经系统激活或钾缺乏，或两者兼而有之，可能会抵消因血压降低和钠缺乏引起的动脉扩张性改善。基于流行病学、临床和药理学研究，这篇综述表明，在原发性高血压患者中，饮食中钠摄入量的变化或利尿剂的使用，或两者兼而有之，会独立于血压变化影响大动脉状态。
