Miyagi University of Education Medical Center, Sendai, Japan.
Wakuya National Health Insurance Hospital, Miyagi, Japan.
Am J Hypertens. 2021 Aug 9;34(8):851-857. doi: 10.1093/ajh/hpab057.
Central pulse pressure (cPP) is responsible for the hemodynamics of vital organs, and monitoring this parameter is important for cardiovascular disease (CVD) prevention. Excess sodium intake and (micro)albuminuria (a manifestation of renal microvascular damage) are known to be strong predictors of CVD. We sought to investigate the cross-sectional relationships among dietary sodium intake, albuminuria, and cPP in a general population cohort.
The subjects were 933 apparently healthy adults (mean age, 56 ± 10 years). Radial pressure waveforms were recorded with applanation tonometry to estimate mean arterial pressure (MAP), cPP, forward and backward pressure amplitudes, and augmentation index. The urinary sodium/creatinine and albumin/creatinine ratios were measured in spot urine samples.
Both the urinary sodium/creatinine and albumin/creatinine ratios were positively correlated with cPP, even after adjusting for MAP (P < 0.001). Moreover, both ratios had a synergistic influence on increasing the cPP independent of age, sex, estimated glomerular filtration rate, hyperlipidemia, and diabetes (interaction P = 0.04). A similar synergistic influence was found on the forward pressure amplitude, but not on the backward pressure amplitude or augmentation index. The overall results were not altered when the urinary albumin/creatinine ratio was replaced with the existence of chronic kidney disease (CKD).
(Micro)albuminuria strengthens the positive association between urinary sodium excretion and cPP and systolic forward pressure. Excess sodium intake may magnify the cardiovascular risk by widening the aortic pulsatile pressure, particularly in the presence of concomitant CKD.
中心脉压（cPP）负责重要器官的血液动力学，监测该参数对于心血管疾病（CVD）的预防很重要。已知钠摄入过多和（微量）白蛋白尿（肾微血管损伤的表现）是 CVD 的强预测因子。我们试图在一般人群队列中调查饮食钠摄入量、白蛋白尿和 cPP 之间的横断面关系。
受试者为 933 名看似健康的成年人（平均年龄 56 ± 10 岁）。用平板张力法记录桡动脉压力波形，以估计平均动脉压（MAP）、cPP、前向和后向压力幅度以及增强指数。在随机尿样中测量尿钠/肌酐和白蛋白/肌酐比值。
尿钠/肌酐和白蛋白/肌酐比值均与 cPP 呈正相关，即使在校正 MAP 后也是如此（P < 0.001）。此外，这两个比值都具有协同作用，可以独立于年龄、性别、估计肾小球滤过率、高脂血症和糖尿病增加 cPP（交互 P = 0.04）。在正向压力幅度上也发现了类似的协同作用，但在后向压力幅度或增强指数上则没有。当用慢性肾脏病（CKD）的存在替代尿白蛋白/肌酐比值时，总体结果没有改变。
（微量）白蛋白尿增强了尿钠排泄与 cPP 和收缩期正向压力之间的正相关关系。钠摄入过多可能通过扩大主动脉脉动压力来增加心血管风险，特别是在伴有 CKD 的情况下。
