Du Xiaofu, Fang Le, Xu Jianwei, Chen Xiangyu, Bai Yamin, Zhong Jieming
Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China.
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China.
Sci Rep. 2021 Feb 10;11(1):3474. doi: 10.1038/s41598-021-83049-8.
The direction and magnitude of the association between sodium and potassium excretion and blood pressure (BP) may differ depending on the characteristics of the study participant or the intake assessment method. Our objective was to assess the relationship between BP, hypertension and 24-h urinary sodium and potassium excretion among Chinese adults. A total of 1424 provincially representative Chinese residents aged 18 to 69 years participated in a cross-sectional survey in 2017 that included demographic data, physical measurements and 24-h urine collection. In this study, the average 24-h urinary sodium and potassium excretion and sodium-to-potassium ratio were 3811.4 mg/day, 1449.3 mg/day, and 4.9, respectively. After multivariable adjustment, each 1000 mg difference in 24-h urinary sodium excretion was significantly associated with systolic BP (0.64 mm Hg; 95% confidence interval [CI] 0.05-1.24) and diastolic BP (0.45 mm Hg; 95% CI 0.08-0.81), and each 1000 mg difference in 24-h urinary potassium excretion was inversely associated with systolic BP (- 3.07 mm Hg; 95% CI - 4.57 to - 1.57) and diastolic BP (- 0.94 mm Hg; 95% CI - 1.87 to - 0.02). The sodium-to-potassium ratio was significantly associated with systolic BP (0.78 mm Hg; 95% CI 0.42-1.13) and diastolic BP (0.31 mm Hg; 95% CI 0.10-0.53) per 1-unit increase. These associations were mainly driven by the hypertensive group. Those with a sodium intake above about 4900 mg/24 h or with a potassium intake below about 1000 mg/24 h had a higher risk of hypertension. At higher but not lower levels of 24-h urinary sodium excretion, potassium can better blunt the sodium-BP relationship. The adjusted odds ratios (ORs) of hypertension in the highest quartile compared with the lowest quartile of excretion were 0.54 (95% CI 0.35-0.84) for potassium and 1.71 (95% CI 1.16-2.51) for the sodium-to-potassium ratio, while the corresponding OR for sodium was not significant (OR, 1.28; 95% CI 0.83-1.98). Our results showed that the sodium intake was significantly associated with BP among hypertensive patients and the inverse association between potassium intake and BP was stronger and involved a larger fraction of the population, especially those with a potassium intake below 1000 mg/24 h should probably increase their potassium intake.
钠和钾排泄与血压（BP）之间关联的方向和强度可能因研究参与者的特征或摄入量评估方法而异。我们的目标是评估中国成年人血压、高血压与24小时尿钠和钾排泄之间的关系。2017年，共有1424名年龄在18至69岁的具有省级代表性的中国居民参加了一项横断面调查，该调查包括人口统计学数据、体格测量和24小时尿液收集。在本研究中，24小时尿钠和钾排泄的平均值以及钠钾比分别为3811.4毫克/天、1449.3毫克/天和4.9。经过多变量调整后，24小时尿钠排泄每相差1000毫克与收缩压显著相关（0.64毫米汞柱；95%置信区间[CI]0.05 - 1.24）和舒张压（0.45毫米汞柱；95%CI 0.08 - 0.81），24小时尿钾排泄每相差1000毫克与收缩压呈负相关（-3.07毫米汞柱；95%CI -4.57至-1.57）和舒张压（-0.94毫米汞柱；95%CI -1.87至-0.02）。钠钾比每增加1个单位与收缩压（0.78毫米汞柱；95%CI 0.42 - 1.13）和舒张压（0.31毫米汞柱；95%CI 0.10 - 0.53）显著相关。这些关联主要由高血压组驱动。钠摄入量高于约4900毫克/24小时或钾摄入量低于约1000毫克/24小时的人群患高血压的风险更高。在24小时尿钠排泄处于较高而非较低水平时，钾能更好地减弱钠与血压的关系。排泄量最高四分位数与最低四分位数相比，高血压的调整优势比（OR）对于钾为0.54（95%CI 0.35 - 0.84），对于钠钾比为1.71（95%CI 1.16 - 2.51），而钠的相应OR不显著（OR，1.28；95%CI 0.83 - 1.98）。我们的结果表明，高血压患者中钠摄入量与血压显著相关，钾摄入量与血压之间的负相关更强且涉及更大比例的人群，尤其是那些钾摄入量低于1000毫克/24小时的人可能应增加钾的摄入量。
